Vistarr Eye Care Centers of West Chester

CATARACTS The clouding of the lenses of our eyes — cataracts — is the principal cause of blindness worldwide. In the U.S. over 22 million people over the age of 40 have cataracts, and this number is expected to grow to 33 million by 2020. The team at Vistarr Laser & Vision has vast experience in cataract surgery, replacing the cloudy lens with a clear artificial lens, returning clear vision to our patients. WHAT ARE CATARACTS? Cataracts affect the eye’s natural lens, which lies behind the iris and the pupil. The lens is a clear film that focuses what the eye is seeing on the light-sensitive retina, which is located on the back of the eye. The lens is crystal clear when we are young, but with age and factors such as sun exposure, proteins in the eye form clumps that begin to cloud the lens. As the proteins build, the lens becomes cloudier, eventually affecting visual acuity, especially at night. Vision through a cataract-clouded lens can be akin to looking through a dirty window. Cataracts develop slowly, so the patient usually doesn’t notice the increasing cloudiness until at some point it begins to impact the vision in the eye with the cataract. Cataracts can develop in both eyes, but they don’t usually form at the same time or progress at the same rate. Cataracts are common in older people. In the U.S., it’s estimated that an 80-year-old has a 50/50 chance of either having cataracts or already having had cataract surgery. Cataracts can only be treated with surgery to replace the permanently clouded lens. WHAT ARE THE DIFFERENT TYPES OF CATARACTS? Cataracts can be classified in different ways: partial or complete, stationary or progressive, hard or soft. They can be classified by the degree of cloudiness of the lens. These are the three main types of cataracts: Nuclear Sclerotic Cataract –The most common form of cataract, the name derives from the nuclear (or central) portion of the lens. Cataracts form in the middle of the lens and turn it brown or yellow. Nuclear sclerotic cataracts usually affect distance vision. Posterior Subcapsular – Predominantly a problem for diabetics or those taking high doses of steroids, posterior subcapsular cataracts form at the back surface of the lens. Cortical Cataract –These cataracts are wedge-shaped and form around the edges of the lens center. To our doctors looking through an ophthalmoscope, these cataracts appear as white spokes on a wheel. Cortical cataracts create problems with glare and tend to scatter light at night. WHAT ARE THE RISK FACTORS FOR DEVELOPING CATARACTS? Aging is the foremost factor in a person developing cataracts, but there are other risk factors involved: Diabetes Excessive sun exposure Smoking Excessive alcohol use Obesity Exposure to radiation from cancer treatments High blood pressure Previous eye injury Previous eye surgery Prolonged use of corticosteroids Family history WHAT ARE THE SYMPTOMS IF I HAVE CATARACTS? Pain is not involved with the development of cataracts. As mentioned above, the process is a slow one, with the person often not realizing their vision is degrading. These are typical symptoms: Decreased color vibrancy Blurred vision Poor night vision Increased glare Halos surrounding lights Double vision Frequently changing eyeglass prescription A feeling there is a film over the eye

Patients with diabetes are at a higher risk for developing eye conditions as a complication their disease. Over 40 percent of patients diagnosed with diabetes develop some form of eye disease as a result of their disease. Diabetic retinopathy is the most common diabetic eye disease and the primary cause of blindness in the United States.Diabetes can damage blood vessels in the eye, causing blood or fluid to leak from the retina, the light-sensitive tissue at the back of the eye. It can also cause new blood vessels to grow on the surface of the retina, leading to significant damage to vision and the overall quality of life. Diabetic eye disease is a combination of various eye conditions that develop as a result of diabetes. These conditions include: -Diabetic retinopathy -Cataracts -Glaucoma STAGES OF DIABETIC RETINOPATHY There are four distinct stages of diabetic retinopathy. They are: 1. Mild nonproliferative retinopathy – microaneurysms develop in the tiny blood vessels of the retina 2. Moderate nonproliferative retinopathy – blood vessels to the retina become blocked 3. Severe nonproliferative retinopathy – the blood supply to the retina is blocked 4. Proliferative retinopathy – New blood vessels, to replace the blocked blood vessels, grow alongside the retina During any stage of diabetic retinopathy a condition known as macular edema can develop. Macular edema is the buildup of fluid in the macula, the light-sensitive part of the retina that allows us to see objects with great detail. As the macula swells vision becomes blurred. About half of the people with proliferative retinopathy are diagnosed with macular edema. SYMPTOMS OF DIABETIC RETINOPATHY Early stages of diabetic retinopathy usually do not show symptoms. Treatment is not always required. Patients need to monitor their blood sugar level to prevent the disease from progressing. If the disease does progress, prompt treatment will be necessary to preserve your vision. Patients who develop diabetic retinopathy may not notice any changes to their vision at first. In its earliest stages, this condition causes tiny areas of swelling in the small blood vessels of the retina. Symptoms of diabetic retinopathy may include the following: -Vision that may be blurry or doubled -Flashing lights -Blank spots -Dark floaters or spots in the vision -Pain or pressure in either or both eyes -Problems with peripheral vision -Severe vision loss or blindness DIAGNOSIS OF DIABETIC RETINOPATHY After a thorough medical examination of the eyes, some of the following diagnostic tests will be conducted at Vistarr Laser & Vision Centers in West Chester, Kennett Square, and Paoli, PA, to confirm the diagnosis: -Visual acuity test -Dilated eye examination -Tonometry test -Retinal exam -Fluorescein angiogram TREATMENT OF DIABETIC RETINOPATHY 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 scattering 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 correct 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. REDUCING THE RISKS OF DEVELOPING DIABETIC RETINOPATHY Patients with diabetes need to have an annual comprehensive dilated eye exam. The length of time a patient has diabetes will determine the likelihood of developing diabetic retinopathy. Over 40 percent of patients in the United States, diagnosed with diabetes, have a form of diabetic retinopathy. The risks of developing diabetic eye disease can be minimized by: -Monitoring changes in vision -Keeping A1C levels under 7% -Monitoring and managing blood pressure levels -Eating a healthy diet -Participating in a regular exercise routine -Monitoring and managing cholesterol levels

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. Get help from Vistarr Laser & Vision Centers in West Chester, Kennett Square, and Paoli, PA. 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. 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: -Vitamin and mineral supplementation are 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 a much improved vision for those with the disorder.

Retinal detachment occurs when the retina of the eye is pulled away from the underlying tissue to which it is attached. A retinal detachment is a medical emergency which can lead to permanent blindness if left untreated. In most cases, the detachment is a slowly progressing issue which must be treated once symptoms are realized. In some cases, a detachment occurs due to a trauma which causes a tear in the retina, allowing fluid to enter the vitreous and pull on the retinal tissue. CAUSES OF A RETINAL DETACHMENT Retinal detachment can be complication of cataract surgery. A severe inflammation may alter the position of the retinal tissue and begin the detachment process. Other causes of a retinal detachment may be as follows: -Nearsightedness -A retinal tear -Family history of retinal detachment -Glaucoma -Cataract surgery -Trauma -Existing eye condition SYMPTOMS OF A RETINAL DETACHMENT Symptoms of retinal detachment may progress slowly or rapidly, but both should be reported to a medical doctor as soon as possible so as to minimize the risk of vision loss. Some of the symptoms of a retinal detachment include: -A sudden decrease in visual acuity -A sudden increase of “floaters” in vision -Bright flashes in the periphery -An unnatural “curving” of straight lines -Loss of central vision -A dense shadow throughout the visual field The patient should be taken to an emergency room as quickly as possible. DIAGNOSIS OF A RETINAL DETACHMENT Diagnosis of a retinal detachment is made after a thorough medical eye examination and the performance of the following diagnostic tests: -Dilated eye examination -Ultrasound of the eye -Fundus photography of the retina -Visual acuity test -Slit-lamp examination -Electroretinogram -Fluorescein angiography -Ophthalmoscopy TREATMENT OF A RETINAL DETACHMENT A retinal detachment may be treated in many ways, which may include one or both of the following: -Cryotherapy -Laser photocoagulation -Pneumatic retinopexy -Scleral buckle -Vitrectomy Most surgeries to repair a retinal detachment are successful. In some cases, a second procedure will need to be performed. After a successful procedure, vision will take time to improve but may not return to previous levels of acuity.

VITRECTOMY The center of the eye is composed of a clear, gel-like substance known as the vitreous. The vitreous is more than 30 percent of the eye’s volume, providing the eye with its shape. Due to the size and consistency of the vitreous it is prone to diseases that cause the vitreous to: -Cloud -Fill with blood -Harden -Prevent light from reaching the retina These diseases may lead to blurred vision, tears or other serious conditions. CONDITIONS TREATED WITH A VITRECTOMY Patients with a disease or injury to the vitreous may require a vitrectomy to address their condition. Some of these conditions include: -Vitreous floaters -Retinal detachment -Macular pucker -Macular hole -Diabetic retinopathy -Vitreous hemorrhage -Vitreous injury or infection THE VITRECTOMY PROCEDURE A vitrectomy removes the vitreous by suctioning it out with tiny instruments inserted into the eye. Upon removal, the retina may be treated with a laser to: -Cut or remove scar tissue -Flatten detached areas of the retina -Repair holes or tears in the retina Patients may experience mild discomfort and redness for several days after this procedure, and may wear an eye patch for a few days. While results vary, depending on the individual condition treated, most patients experience an improved visual acuity after the procedure. COMPLICATIONS OF A VITRECTOMY There are certain risks associated with any surgical procedure. Some of these risks include retinal detachment, fluid buildup, growth of new blood vessels, infection and further bleeding into the vitreous gel.

DRY EYE TREATMENT 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 at Vistarr in West Chester, Kennett Square, & Paoli, PA, 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 -Topical Medications – Restasis and Xiidsa -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.

EYE INFECTIONS Eye infections can occur when a patient has been exposed to a virus, fungus or bacterium. Different types of infections strike particular portions of the eye. Both eyes or only one may become infected. SYMPTOMS OF AN EYE INFECTION Common symptoms of an eye infection may include the following symptoms: -Red eyes -Itchy eyes -Pain, discharge -Inflammation in the eye area -Vision difficulties COMMON EYE INFECTIONS Two of the most typical forms of eye infections include conjunctivitis, also known as pink eye, and styes. CONJUNCTIVITIS Conjunctivitis is a contagious infection of the conjunctiva, the membrane that lines the eyelid and covers the white part of the eyeball. It produces inflammation that affects the blood vessels and gives the eye a pink or red appearance. STYES Styes are small red bumps that develop along the eyelid as a result of a bacterial infection of the hair follicle of an eyelash. Styes may cause pain, swelling and tearing of the eye. TREATMENT OF EYE INFECTIONS Treatment for an eye infection will vary depending on its cause. Some may go away on their own, while others will require the use of warm compresses, over-the-counter medications or antibiotic eye drops. Patients should avoid wearing makeup or contact lenses until after the infection is gone.

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.

The vitreous is the gelatinous-like substance that makes up approximately two-thirds of the eye’s volume. The vitreous is located in between the lens, in the front of the eye, and the retina, in the back of the eye. In a normal, healthy vitreous, there are no blood vessels, yet diseases, such as diabetic retinopathy, can lead to the development of new blood vessels which grow into the vitreous gel. These blood vessels are often fragile and susceptible to leaking blood and fluids. CAUSES OF A VITREOUS HEMORRHAGE A vitreous hemorrhage occurs when a blood vessels ruptures and causes bleeding within the vitreous gel, causing visual symptoms. There are various causes of a vitreous hemorrhage, including: -Diabetic retinopathy -Sickle cell retinopathy -Retinal vein occlusion -Retinopathy of prematurity -Ocular ischemic syndrome -Posterior vitreous detachment -Retinal detachment -Terson’s syndrome -Retinal macroaneurysms -Tumor -Leukemia -Nearsightedness -Carotid artery disease -Trauma -Choroidal neovascularization SYMPTOMS OF A VITREOUS HEMORRHAGE Patients with vitreous hemorrhage usually notice the following symptoms: -A sudden, significant increase in the number and size of floaters blocking their vision -Vision loss -Blurry, cloudy or hazy vision -Flashes of light When symptoms occur, it is important for patients to seek prompt medical attention. DIAGNOSIS OF A VITREOUS HEMORRHAGE The doctor will examine the patient’s eyes as well as review their medical history to determine the cause of the hemorrhage. An appropriate treatment will be recommended. To confirm the diagnosis, a series of diagnostic tests may be performed such as: -Gonioscopy -IOP -B-scan -Dilated eye examination -Indirect ophthalmoscopy -Slit-lamp examination TREATMENT OF A VITREOUS HEMORRHAGE If a retinal detachment or break is diagnosed, a vitrectomy is performed immediately. Treatment for a vitreous hemorrhage will be determined based on the underlying cause of the condition. Some of the treatments for a vitreous hemorrhage include: -Vitrectomy -Cryotherapy -Laser photocoagulation -Intravitreal Injections -Observation

Iritis, also known as anterior uveitis, is an inflammation of the iris, the colored portion of the eye. Iritis usually develops quickly and may only affect one eye. CAUSES OF IRITIS The causes of iritis are unknown but it has been caused by some of the following: -Trauma to the eye -Infection -Shingles, or Herpes zoster ophthalmicus -Autoimmune disease -Juvenile rheumatoid arthritis -Reaction to medication SYMPTOMS OF IRITIS The symptoms of iritis usually develop quickly and unexpectedly, while in some individuals they form slowly. Distinguishing symptoms of iritis may include: -Irritation and redness of the eye -Eye pain -Sensitivity to light -Blurred vision -The appearance of floaters DIAGNOSIS OF IRITIS Iritis is diagnosed after a physical examination of the eye has taken place. In order to confirm diagnosis, the doctor may perform the following tests: -Slit lamp examination -Visual acuity examination -Test for glaucoma As a light is focused on the eyes, the eye with iritis will experience pain because of the constriction of the pupil. TREATMENT OF IRITIS To treat iritis, the patient will be encouraged to wear dark glasses and take drops to dilate the pupil to relieve pain and pressure. Serious cases of iritis may require an extended use of steroid eye drops as well as oral steroids to suppress the immune system. Iritis that results from an underlying condition such as herpes, AIDS or syphilis, will see improvement in the eye and iris once the disease is treated otherwise, iritis may become a chronic condition.

A chalazion is a small, non-infectious lump that develops in the upper or lower eyelid due to the blockage of the meibomian gland, an oil gland in the eyelid. The meibomian gland produces fluid that lubricates the eye. While children do develop chalazions, they more commonly affect adults between the ages of 30 to 50. CAUSES OF CHALAZION There are almost 100 meibomian glands in the eyelid, located near the eyelashes. When the duct that drains the gland is blocked, the fluid becomes backed up inside the gland and forms a chalazion. A chalazion may also form as a result of an eyelid infection. SYMPTOMS OF CHALAZION -A bump or lump in eyelid -Tenderness of the eyelid -Sensitivity to light -Excessive tearing -Blurry vision -Blepharitis -Astigmatism TREATMENT OF CHALAZION Chalazion usually resolve on their own, over the course of time. It can take a few months before they disappear. To treat a chalazion, the following options are available: -Warm compress applied 4 times day for 10 to 15 minutes each time -Antibiotic ointment -Steroid injection -Surgical drainage While older children and adults may undergo the surgical drainage procedure in a doctor’s office under local anesthesia, general anesthesia is usually recommended for a chalazion removal in young children. If a chalazion recurs in the same place, a tissue biopsy may be conducted in order to rule out a more serious issue.

A contact lens is a thin, convex disc that floats on the surface of the eye, providing vision correction. With advances in optical technology, most people can use contact lenses, regardless of the type or extent of their vision problems. This includes patients with astigmatism and those who need bifocals or multifocal lenses. In some cases, however, contact lenses are contraindicated. TYPES OF CONTACT LENSES There are several varieties of contact lenses offered at Vistarr Laser & Vision Centers in Kennett Square, Paoli, and West Chester, PA. The distinctive features of each offer a wide range of options. SOFT CONTACT LENSES There are three basic types of soft contact lenses. DAILY-WEAR LENSES Daily-wear soft contact lenses are the most popular type of contacts available. Made of a flexible plastic polymer, daily-wear lenses are put in each morning and taken out each night. Daily-wear contacts come in many colors and typically last about 1 year. EXTENDED-WEAR LENSES Extended-wear soft contact lenses can be worn all the time, including while sleeping. Depending on whether a person has 7-day (standard) or 30-day lenses, the lenses need to be taken out and cleaned once a week or once a month. This is done to give the eyes a rest, and reduce the risk of a corneal infection. Extended-wear lenses are made of soft silicone that retains moisture longer than daily-wear contacts. This allows more oxygen to reach the eye, preventing the buildup of bacteria and protein. DISPOSABLE-WEAR LENSES Disposable soft lenses are intended to be discarded and replaced after they have been worn for a certain period of time. This makes them even easier to maintain than regular soft contacts. Many disposable lenses are designed for either replacement every morning, every two weeks or every month. Daily-wear disposables are worn during waking hours only, while extended-wear disposables can be worn during sleep as well. GAS-PERMEABLE LENSES Rigid, gas-permeable contacts have several advantages, including the following, over soft lenses: -Correction of a wider range of vision problems -Sharper vision than with most soft lenses -More oxygen flow through to the eye, reducing risk of corneal irritation -More durability than soft lenses, and less prone to deposit buildup Because they are much harder than flexible contacts, gas-permeable lenses take some getting used to when they are first worn. They are also more likely than soft lenses to slip off the center of the eye and require adjustment, making them an inconvenient choice for patients who play sports or participate in other vigorous activities. Most patients, however, grow accustomed to the feel of gas-permeable lenses and are satisfied with the improvement in the vision they offer. Choice of lens is based on doctor recommendation and patient need. Most ophthalmologists offer a comprehensive array of contact lenses to suit their patients’ needs. Prescriptions are required for all contact lenses.

In addition to the comprehensive ophthalmology services we provide, our practice features an optical center with a wide array of eyeglass frames and contact lenses to suit every look and budget. Patients can choose frames from many elite designers, as well as stylish yet affordable alternatives. In addition, we carry a full line of frames for children and teens and a great selection of athletic eyewear. Our convenient onsite location eliminates the hassle of having to take your prescription to another location in order to fill your vision correction needs. EYEGLASS FRAMES When visiting our optical center, patients will be seen by one of our experienced opticians, who will help you decide which frames are best for you. Many factors are taken into consideration, including your personal style, the shape of your face and your coloring. We offer a tremendous variety of eyewear from top quality designer and fashion manufacturers to fit every style. CHOOSING THE RIGHT LENSES Choosing the right lenses for your prescription needs is just as important as finding a frame that suits you. There are many options available today and our knowledgeable staff is happy to help you find the one that is best for you. Some lenses are thinner and lighter than others, lending themselves to stronger prescriptions, rimless styles, and smaller frames. Others are top-of-the-line polycarbonate for the maximum scratch and impact resistance available, which makes them perfect for active individuals. Some of the most popular, useful features chosen by our customers are anti-reflective coatings, dirt resistance and provide 100% UVA and UVB protection.

Blepharoplasty, also known as eyelid surgery, is a surgical procedure that improves the appearance of the eyelids by tightening muscles and tissue or removing excess fat and skin. A lower eyelid blepharoplasty is used to treat the following: -Under-eye bags -Drooping lower eyelids -Excess skin -Fine wrinkles A lower eyelid blepharoplasty can be performed on adult men and women alike and offers a younger, more refreshed look that reflects the whole face. Blepharoplasty is one of the most commonly performed facial plastic surgery procedures. The popularity of this procedure reflects the importance of the eyes in perfecting overall appearance. If the appearance of the eyes causes a patient to be unhappy, they may want to consider lower eyelid blepharoplasty to improve their look and boost their confidence through a safe procedure with minimal downtime. CANDIDATES FOR A LOWER EYELID BLEPHAROPLASTY The best candidates for lower eyelid blepharoplasty are those individuals who meet the following conditions: -Are in good overall health -Do not smoke -Do not have any serious eye conditions -Have healthy facial tissue and muscle If a patient has loose, sagging skin or puffy bags under their eyes, this procedure can help reduce these unwanted effects and leave the eyes looking young and fresh. It is important for patients to have realistic expectations before undergoing a lower eyelid blepharoplasty procedure in order to be satisfied with their results. While the procedure can enhance their appearance and may improve self-confidence as a result, it cannot alter a patient’s entire appearance or change the structure of their face. THE LOWER EYELID BLEPHAROPLASTY PROCEDURE The lower eyelid blepharoplasty procedure is performed with local anesthesia. The method or procedure to be used will be determined by the amount of fat that needs to be removed, the location of the fat and how tight to make the eyelid. The procedure typically takes from 45 minutes to an hour. There are several different surgical approaches that can be used in a lower eyelid blepharoplasty. They are as follows: TRANSCONJUNCTIVAL LOWER LID BLEPHAROPLASTY Often chosen when no skin needs to be removed, a transconjunctival lower lid blepharoplasty creates an incision on the inside of the lower eyelid, leaving no visible scar or other evidence of the surgery. TRANSCUTANEOUS LOWER LID BLEPHAROPLASTY A transcutaneous lower lid blepharoplasty is performed with a subciliary incision, also known as a pinch technique, to remove protruding fat and excess skin. RECOVERY AFTER A LOWER EYELID BLEPHAROPLASTY After the lower eyelid blepharoplasty procedure, the surgeon may recommend applying lubricating drops or ointment and cold compresses to aid in the healing process and minimize side effects such as: -Swelling -Bruising -Irritation -Dry eyes The eyes may be wrapped in gauze after the procedure as well. Patients can usually return to work within a few days, but should avoid exercise and strenuous activities for at least two weeks. Stitches are usually removed three or four days after the procedure. Swelling and other side effects usually subside within two weeks after surgery. Contact lenses and eyelid make-up may not be worn for two weeks after surgery. The surgeon will give specific instructions on how to care for the eyes post-procedure. RESULTS OF A LOWER EYELID BLEPHAROPLASTY PROCEDURE The results of a lower eyelid blepharoplasty procedure are visible as swelling and bruising subside and will continue to improve for up to a year after surgery. The lower eyelid blepharoplasty procedure is designed to produce long-lasting results. While surgery cannot prevent the eyes from aging, most patients are satisfied with their results and do not seek a repeat procedure. RISKS AND COMPLICATIONS OF A LOWER EYELID BLEPHAROPLASTY As with any surgical procedure, there are certain risks associated with a lower eyelid blepharoplasty procedure. While rare, these risks include the following: -Bruising -Swelling -Blurry vision -Malposition of the eye -Bleeding -Infection -Dry eyes -Skin discoloration -An inability to fully close the eyes

After undergoing an eyelid surgery, or blepharoplasty, if the results are not up to the patient’s expectations, it can be disappointing. It is always prudent to wait a few months, after the procedure, to determine how the eyes will truly look once the swelling has gone down and healing has taken place. If a patient is still not satisfied at that point, however, a consultation can help them explore their options for an eyelid revision procedure. Complications that may occur after a blepharoplasty procedure, include some of the following: -Lower eyelid retraction -Discomfort or pain -Blurry vision -Exposure keratopathy -Lack of symmetry Every patient and each case is different. In cases of overcorrection, in which too much tissue was removed, the remaining eyelid skin can often be redistributed to improve the result. When an undercorrection is the problem and not enough tissue was removed, another blepharoplasty procedure may need to be performed to achieve the patient’s desired appearance.

ENTROPION Entropion is an eye condition where the eyelid turns inward. Typically entropion occurs on the lower eyelid where the skin and lashes rub painfully against the cornea. This condition may cause the lid to either turn in constantly or only at times when the eyes are closed tightly. CAUSES OF ENTROPION Entropion usually occurs in older adults as a result of the aging process. In adults the muscles around the eyes may progressively weaken. A spasm or relaxation of the muscles near the eye can cause the lid to turn inward. Other causes of entropion include: -Injury -Muscle weakness -Congenital defect -Skin disease -Inflammation -Surgery SYMPTOMS OF ENTROPION The initial symptoms of entropion are often the following: -Pain in the eye -Excessive tearing -Redness -Irritation -Pain -Dry eyes -Sensitivity to light -Reduced vision -Discharge from the eye -A feeling that there is something in the eye Patients experiencing light sensitivity should contact their physician immediately. Without treatment a decrease in vision can occur. The doctor will be able to confirm the diagnosis of entropion upon an examination of the eyes. TREATMENT OF ENTROPION While there are treatments for entropion, correction of the condition is completed with a brief surgical procedure in which the eyelids are repositioned. Temporary relief of the entropion condition can also be found with the following treatment methods: Skin tape to hold the eyelid in place Strategically placed stitches Lubricating eye drops SURGICAL CORRECTION OF ENTROPION The eyelid area is numbed with a local anesthetic and a light sedation may also be provided. For entropion due to muscle weakness, the surgery may involve the removal of a small section of eyelid to tighten the muscles in the area. When the entropion is caused by scars or prior surgery, the procedure typically relies on a skin graft to allow a repositioning of the eyelid. Patients usually need to wear an eye patch for 24 hours after the surgery. Post-operatively an antibiotic and steroid ointment will need to be applied. Symptoms of entropion usually resolve immediately. There may be some short-term bruising or swelling as a result of the procedure. ECTROPION Ectropion is an eye condition in which the eyelid turns outward. It typically affects the lower eyelid, exposing the inner lid in either one section of eye or across the entire lid. Ectropion prevents tears from draining from the eye correctly, resulting in irritation. It usually occurs in older adults as a result of the aging process, during which muscles, tendons and connective tissue around the eyes progressively weaken. Those who have had trauma to the face or eyes are at greater risk of developing ectropion. CAUSES OF ECTROPION In addition to aging, there are a number of causes of ectropion: -Facial paralysis due to Bell’s palsy or tumor -Facial scarring from burns or other trauma -Eyelid growths (malignant or benign) -Previous eyelid surgery (blepharoplasty) -Radiation of the eyelid to treat a cancerous growth -Excessive sun exposure -Rapid weight loss -Cosmetic laser-skin resurfacing -Certain eye drop medications, such as those used to treat glaucoma In rare cases, ectropion is a congenital condition. It is usually found in infants with another genetic disorder, such as Down syndrome. SYMPTOMS OF ECTROPION In patients with ectropion, tears do not drain properly into the small openings on the inner part of the lid (puncta). This poor drainage causes several symptoms that include the following: -Eye irritation and redness -Excessive tearing -Pain -Sensitivity to light -Inflammation -Eyes that feel dry or gritty Patients with ectropion should be aware of its possible complications, and report any worsening of symptoms immediately. COMPLICATIONS OF ECTROPION Several serious complications, including the following, can result from ectropion: -Corneal abrasions -Corneal ulcers -Eye infections Evidence of complications includes eye pain, sensitivity to light or rapidly increasing redness, or a decrease in vision. Any worsening of ectropion symptoms is a sign that vision is in jeopardy and emergency treatment should be sought. TREATMENT OF ECTROPION While there are temporary-relief treatments, such as artificial tears or soothing ointment, correction of ectropion is accomplished with a brief surgical procedure in which the eyelids are repositioned. For ectropion due to muscle weakness or scars from a previous surgery, the repair procedure may include the following: -Stretching of scar tissue -Removal of a small section of eyelid -Skin graft to reposition the eyelid During recovery, an antibiotic and steroid ointment must be administered. Though there may be some short-term bruising or swelling after the operation, the symptoms of ectropion usually resolve immediately.

A pterygium is a painless, non-cancerous growth of the conjunctiva, the lining that covers the white part of the eye. The pterygium may grow on the cornea, which covers the iris, the colored part of the eye. A pterygium usually begins on the nasal side of the eye and can be different colors, including red, pink, white, yellow or gray. Patients with pterygium often first notice the condition because of the appearance of a lesion on their eye or because of dry, itchy irritation, tearing or redness. Pterygium is initially noticed when it is confined only to the conjunctiva. At this stage of development, it is called a pinguecula. As it extends to the cornea it is termed a pterygium and can eventually lead to impaired vision. Pterygium is diagnosed after a thorough medical examination of the eyes. A slit-lamp examination will allow the physician to examine the cornea, iris, and lens to confirm the diagnosis. CAUSES OF PTERYGIUM While the causes of pterygium are not entirely known, it is believed to be caused mainly by exposure to UV light. Other suspected causes include living in a dry, dusty, and windy environment. People who live near the equator or play water sports such as surfing and fishing are more likely to develop pterygium. Prolonged exposure to these conditions causes the conjunctiva to thicken and the eye to become red and irritated. Collagen in the eye begins to deteriorate, and the eye weakens. Studies show that there may also be a genetic predisposition to pterygium, with a higher prevalence occurring in men more than women. SYMPTOMS OF PTERYGIUM Symptoms of pterygium include: -Tissue in the inner or outer corner of the eye -Dry eyes -Redness of the eye -Irritation -Inflammation -Tearing -Burning of the eye -Blurry vision In more severe cases, the pterygium may grow over the pupil and limit vision. SURGICAL TREATMENT OF PTERYGIUM In most mild cases of pterygium, artificial tears can be used to reduce dryness and irritation. For those patients with severe cases of pterygium and whose vision has been affected, different types of surgery are available. Surgery is the only way to definitively remove a pterygium, but it is not a perfect solution; it requires long-term follow-up, and the recurrence rate is between 30 to 40 percent. AUTOLOGOUS CONJUNCTIVAL AUTO-GRAFTING A safe and effective technique to surgically remove a pterygium is autologous conjunctival auto-grafting. The pterygium is removed as well as the tissue covering the conjunctiva. The tissue that is removed from the sclera is replaced by tissue that has been removed from the inside of the patient’s upper eyelid. AMNIOTIC MEMBRANE TRANSPLANTATION Amniotic membrane transplantation is another safe and effective procedure to remove a pterygium. Donor tissue from an inner layer of the human placenta is used to reconstruct the surface of the eye. This type of graft encourages healing and reduces swelling. PREVENTION OF PTERYGIUM Sunglasses that block UV rays, particularly sunglasses that provide side coverage, are a good means of protection against pterygium. Wearing a hat with a brim to limit or block sunlight is also helpful. In hot, dry climates, artificial tears should be used to help lubricate the eyes.