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For over 40 years the standard surgical treatment for glaucoma was a procedure called a trabeculectomy.

In a trabeculectomy the ophthalmic surgeon would make a hole in the wall of eye to allow fluid from the inside of the eye to flow out of the eye and then get resorbed by the blood vessels in the conjunctiva (the mucous membrane that covers the white part of the eye).

This surgery often resulted in a large decrease in the Intraocular Pressure (IOP). Reducing the IOP is the goal of glaucoma surgery because multiple studies on glaucoma show that if you can reduce the pressure in glaucoma the progression of the disease slows.

The problem with trabeculectomy is although it frequently lowers the pressure it also has a fairly high complication and/or failure rate. This led to some reluctance to perform the procedure unless the glaucoma was severe, or the pressure was very high. As a result of those issues there has been a search during the last 40 years for something that had a lower complication rate and could be more easily deployed earlier in the disease process.

Enter Minimally Invasive Glaucoma Surgery, or MIGS. There are now several types of surgeries that fit in the MIGS category and many of them are used in conjunction with cataract surgery. They are utilized much earlier in the disease process and when combined with cataract surgery they can be used to not only help control the pressure over the long term but can often even reduce the burden of eye drops afterward.

The biggest advantage to MIGS over the trabeculectomy is that when used in conjunction with cataract surgery MIGS can lower the eye pressure (although not as much as the trabeculectomy) but often with no higher rate of complications as there is with cataract surgery alone.

The lower complication rate is mainly because the MIGS procedures do not create a full-thickness hole in the wall of the eye. Most of them involve putting in some form of stent inside the eye. The stent lets the intraocular fluid get out of the eye more efficiently through its normal internal drain called the trabecular meshwork, rather than having to flow to the outside of the eye as with a trabeculectomy. There are currently several FDA-approved drainage stents with more on the horizon.

A stent is not the only way to lower the pressure along with cataract surgery. There is also a laser treatment you can do from the inside of the eye that slows the amount of fluid the eye makes, which also results in a lower pressure. It is called Endocyclophotocoagulation (ECP). Think of a partially clogged drain in a sink with constantly running water. If you don’t want the sink to overflow (or the pressure in the eye to get too high) you either try to unclog the drain (stent) or you turn down the faucet (ECP).

MIGS has been a great development over the last several years, enabling the ophthalmic surgeon to intervene surgically at a much earlier stage of glaucoma and with a significantly lower complication rate than the more invasive trabeculectomy.

At this point I utilize one of the MIGS procedures in almost all patients who need their cataracts removed and are on one or more glaucoma medications. Even if the glaucoma is fairly well controlled at the time, the MIGS procedure gives us the opportunity to try and get a glaucoma patient off their eye drops, which is both a decreased burden of treatment and lets us keep the eye drops in reserve should the pressure start to increase again later in life.

If you have glaucoma and a cataract you should definitely discuss this with your doctor to see if a MIGS procedure along with your cataract surgery could be the right choice for you.

Article contributed by Dr. Brian Wnorowski, M.D.

1. Vision is so important to humans that almost half of your brain’s capacity is dedicated to visual perception.

2. The most active muscles in your body are the muscles that move your eyes.

3. The surface tissue of your cornea (the epithelium) is one of the quickest-healing tissues in your body. The entire corneal surface can turn over every 7 days.

4. Your eyes can get sunburned. It is called photokeratitis and it can make the corneal epithelium slough off just like your skin peels after a sunburn.

5. Ommatophobia is the fear of eyes.

6. You blink on average about 15 to 20 times per minute. That blink rate may decrease by 50% when you are doing a visually demanding task like reading or working on a computer – and that’s one reason those tasks can lead to more dry-eye symptoms.

7. Your retinas see the world upside down, but your brain flips the image around for you.

8. If you are farsighted (hyperopia) your eye is short, and if you are shortsighted (myopia) your eye is long.

9. An eyelash has a lifespan of about 5 months. If an eyelash falls out it takes about 6 weeks to fully grow back.

10. One in every 12 males has some degree of “color blindness.”

Article contributed by Dr. Brian Wnorowski, M.D.

This blog provides general information and discussion about eye health and related subjects. The words and other content provided on this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately licensed physician. The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ.

There are several different variations of Glaucoma, but in this article we will mainly focus on Primary Open Angle Glaucoma. This means that there is no specific underlying cause for the Glaucoma like inflammation, trauma, or a severe cataract. It also means that the drainage angle where fluid is drained from the inside of the eye into the bloodstream is not narrow or closed.

Closed or Narrow Angle Glaucoma, which will be discussed in another article, is treated differently from Open Angle Glaucoma

In the U.S., Primary Open Angle Glaucoma (POAG) is by far the most common type of Glaucoma we treat.

Glaucoma is a disease where the Optic Nerve in the back of the eye deteriorates over time, and that deterioration has a relationship to the Intraocular Pressure (IOP). Most - but not all - people diagnosed with Glaucoma have an elevated IOP. Some people have fairly normal IOP’s but show the characteristic deterioration in the Optic Nerve. Regardless of whether or not the pressure was high initially, our primary treatment is to lower the IOP. We usually are looking to try to get the IOP down by about 25% from the pre-treatment levels.

The two mainstays of initial treatment for POAG in the U.S. are medications or laser treatments. There are other places in the world where Glaucoma is initially treated with surgery. However, while surgery can often lower the pressure to a greater degree than either medications or laser treatments, it comes with a higher rate of complications. Most U.S. eye doctors elect to go with the more conservative approach and utilize either medications - most often in the form of eye drops - or a laser treatment.

Drops

There are several different classes of medications used to treat Glaucoma.

The most common class used are the Prostaglandin Analogues or PGA’s. The PGA’s available in the U.S. are Xalatan (latanaprost), Travatan (travapost), Lumigan (bimatoprost) and Zioptan (tafluprost).

PGA’s are most doctors’ first line of treatment because they generally lower the IOP better than the other classes; they are reasonably well tolerated by most people; and they are dosed just once a day, while most of the other drugs available have to be used multiple times a day.

The other classes of drugs include beta-blockers that are used once or twice a day; carbonic anhydrase inhibitors (CAI’s ), which come in either a drop or pill form and are used either twice or three times a day; alpha agonists that are used either twice or three times a day; and miotics, which are used three or four times a day. All of these other medications are typically used as either second-line or adjunctive treatment when the PGA’s are not successful in keeping the pressure down as single agents.

There are also several combination drops available in the U.S. that combine two of the second-line agents (Cosopt, Combigan, and Symbrinza).

Laser

The second option as initial treatment is a laser procedure.

The two most common laser treatments for Open Angle Glaucoma are Argon Laser Trabeculoplasty (ALT) or Selective Laser Trabeculoplasty (SLT). These treatments try and get an area inside the eye called the Trabecular Meshwork - where fluid is drained from the inside of the eye into the venous system - to drain more efficiently.

These treatments tend to lower the pressure to about the same degree as the PGA’s do with over 80% of patients achieving a significant decrease in their eye pressure that lasts at least a year. Both laser treatments can be repeated if the pressure begins to rise again in the future but the SLT works slightly better as a repeat procedure compared to the ALT.

Article contributed by Dr. Brian Wnorowski, M.D.

Read more: Holiday Eye Safety Tips

Many people prefer shopping online to shopping in stores for many of their needs.

With technology constantly improving and evolving, people tend to take advantage of the convenience of shopping online. Whether it’s clothing, electronics, or even food, you can easily find almost everything you need on the Internet.

Eyeglasses, unfortunately, are no different. Many online shops have been popping up in recent years, offering people that same convenience. But what they don’t tell you is that it comes at a price, and this article’s purpose is to shine a light on the negatives of shopping online for eyeglasses.

Here are some important reasons to avoid the temptation of ordering glasses online.

Accuracy--Instead of saving the most important point for last, we will start with the main reason that ordering eyeglasses online is a bad idea. Product accuracy is a huge reason that the online market has not completely taken off. Every person who needs eyeglasses needs to understand the process for how their prescription is obtained in order to truly understand why shopping online is a bad idea. It is called an eyeglass prescription for a reason. Your eye doctor is prescribing your lenses as if they were prescribing any form of medication. To take that prescription and hand it over to a website that does not require licensed workers to interpret the prescription is not the wisest choice. Equally as important as the prescription itself are the pupillary distance (PD) measurement, and the optical centers. These measurements are often not given at the time of the examination, but instead are administered by the optician at the point of sale. Not having these measurements done accurately will negatively affect the quality of vision as much as an error in the prescription.
Quality--Similar to the accuracy of the lens, the quality of the product you are purchasing is affected when making the decision to purchase online. The saying “too good to be true” is the case more times than not, and this purchase is no exception. When you see enticing advertisements for pricing that seems to be too good, there is a reason. This product is often not inspected or handled by a state-licensed optician. These websites rely on mass production in order to operate. Factory workers operating machines pale in comparison to the experience you will receive in a professional office. Skilled opticians licensed to interpret and manufacture your eyeglass prescriptions are held to a much higher standard than factory workers.
Warranty--Due to their low prices, many of these websites do not include any form of product warranty or guarantee. Opticians, however, stand behind your purchase. If there are issues with adjustment or a patient not being comfortable in a specific lens or product, professional opticians are willing to work with you. This personal experience is not attainable on the web.
Coordination with your doctor--With the complexity of eyeglass lenses, the ease of working in-house or with a nearby lab is always a benefit worth keeping in mind. Eyeglass lenses can be very complex products. Having the benefit of being able to work directly with the doctor gives the optician the best chance to put you in the exact lenses you need. There is a substantial difference in the percentage of error between shopping online and buying from a local private practice.
Personal Experience--Probably the most important factor for many people, the personal experience you get when shopping in person is something you cannot obtain by using the Internet. Dealing with the same opticians year in and out is something patients emphasize and appreciate. Just like people tend to keep the same doctors over the years, patients like knowing that the same people will be in charge of making their glasses. Shopping online does not offer that experience.

All of these factors should be carefully considered when making the decision where to buy glasses. While the initial price difference could entice you online at first, know that it does come at a price. Warrantied product, quality, and convenience are very important factors when buying glasses. People sometimes tend to discount just how intricate eyeglasses prescriptions and fit really are.

Article contributed by Richard Striffolino Jr.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

No this is not a late-night personal injury lawyer infomercial.

This is a recommendation that you have your LASIK records available, for your own good, later in life.

There are 2 million cataract surgeries done yearly in the U.S. and the odds are, if you live long enough, you will eventually need cataract surgery, too.

What does this have to do with LASIK surgery?

When doctors perform cataract surgery we remove the cataract, which is the lens of your eye that has become cloudy. And we replace that lens with an artificial lens called an Intraocular Lens implant (IOL).

The IOL needs to have a strength to it to match your eye so that things are in focus without the need for strong prescription eyeglasses.

Currently, we determine what the strength the IOL needs to be by using formulas that mostly depend on the measurements of the curvature of the cornea and the length of the eye.

Those formulas work best when the cornea is its natural shape - i.e., not previously altered in shape after LASIK.

If you plug the “new” post-LASIK corneal shape into the formulas, the IOL strength that comes out is often significantly off the strength you really need to see well.

This is where having your records becomes important.

Knowing what your eyeglass prescription and corneal shape was BEFORE you had LASIK greatly improves our formula’s ability to predict the correct implant strength.

In most states there is a limit to how long a doctor needs to keep your records after your last visit, so everyone who has had LASIK surgery should get a copy of your pre- and post-LASIK records NOW before they no longer exist.

Article contributed by Dr. Brian Wnorowski, M.D.

Diabetic retinopathy, which is a complication of diabetes that affects the eyes, is detected during a comprehensive eye exam that includes:

Visual acuity testing.
Dilated exam in which drops are placed to widen the pupil to allow examination of the retina.
Tonometry. Measurement of the eye pressure inside the eye.

Supplemental testing may include:

Optical coherence tomography (OCT). This is a non-invasive test that images the retina to detect any fluid or diabetic macular edema.
Fluorescein Angiography. This test involves an injection of a dye into your arm and a series of pictures that are taken as the dye flows through the retinal vessels. This may show leakage of fluid or the growth of new blood vessels in the retina.

Treatment for Diabetic Retinopathy

The best treatment is prevention of diabetic retinopathy by strict control of blood sugars. Once diabetic retinopathy is present, treatment of diabetic retinopathy will slow progression but won’t cure it.

Diabetic macular edema can be treated with several different therapies that may be used alone or in combination.

These include:

Injection therapy. Anti-VEGF drugs are injected into the eye to block a substance called vascular endothelial growth factor (VEGF). This medication will block abnormal blood vessel growth and decrease the leakage of fluid into the retina. The three most commonly used drugs include Avastin, Lucentis and Eylea. Steroids are another option for treatment of diabetic macular edema but are used less often due to side effects of possible cataracts and increased eye pressure.
Laser therapy. Small laser burns are applied in the area of the retinal swelling to slow the leakage of fluid. Laser treatment can be combined with anti-VEGF injections.

Proliferative diabetic retinopathy can be treated with:

Laser therapy. Laser is applied on the retina to shrink the new blood vessels and to prevent bleeding inside the eye. Bleeding inside the eye will cloud the vision and cause floaters, which are small moving spots that appear in your field of vision.
Surgery. When there is significant amount of blood or scar tissue inside the eye, then a vitrectomy surgery is performed to remove the blood and scar tissue. Laser and anti-VEGF therapy may also be applied during the surgery.

In the end, the best treatment is prevention of diabetic retinopathy. An annual comprehensive dilated eye exam is recommended for anyone who has been diagnosed with diabetes, since early mild non-proliferative diabetic retinopathy can show no symptoms.

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ

Transition lenses in eyeglasses have been around for many years now. The mechanics behind transition lenses is that certain chemicals in the lens interact with UV light from the sun and turn the lenses dark when you go outside and back to clear when you go inside.

This is a great accompaniment to sunglasses, as it is not always convenient to be carrying around multiple pairs of glasses with you, especially when going from inside to outside frequently. However, there are some drawbacks to transitions, including the fact that they don’t get as dark as sunglasses, have some difficulty turning dark in the car, and have a tendency to keep a slight constant tint even in dark conditions.

Vistakon, the optical wing of Johnson & Johnson, has come out with the first transition contact lens. Acuvue Oasys Transitions hit the market recently and while it is still brand-new technology, preliminary results have been generally positive.

Just a couple personal thoughts: It looks a little strange. The material itself turns a dark shade of grey and therefore the person is walking around with eyes that look black. On the plus side, though, this would be good for people limited by high prescriptions and who have difficulty with peripheral vision and glasses, yet still want the transition technology. On the other hand, wearing clear contact lenses with sunglasses would provide better sun coverage with the ability to remove the sunglasses when desired.

There is one other area where transition contacts might become very useful and that is in outdoor sports. For any athlete who is playing an outdoor sport where the lighting conditions may change from day to day or even within a single game or event, these contacts may significantly improve the ability to perform. This is especially true in any sport where there may be significant contact or rapid head movement that can make it difficult to compete in sunglasses.

While in its infancy, transition contact lenses look to be a promising technology.

Article contributed by Dr. Jonathan Gerard

Diabetic retinopathy is an eye condition that affects the retina in people who have diabetes.

The retina is the light-sensitive tissue that lines the back of the eye, and detects light that is then processed as an image by the brain. Chronically high blood sugar or large fluctuations in blood sugar can damage the blood vessels in the retina. This can result in bleeding in the retina or leakage of fluid.

Diabetic retinopathy can be divided into non-proliferative or proliferative diabetic retinopathy.

Non-proliferative diabetic retinopathy: In the early stage of the disease, there is weakening of the blood vessels in the retina that causes out-pouching called microaneurysms. These microaneurysms can leak fluid into the retina. There can also be yellow deposits called hard exudates present in the retina from leaky vessels.

Diabetic macula edema is when the fluid leaks into the region of the retina called the macula. The macula is important for sharp, central vision needed for reading and driving. The accumulation of fluid in the macula causes blurry vision.

Proliferative diabetic retinopathy: As diabetic retinopathy progresses, new blood vessels grow on the surface of the retina. These blood vessels are fragile, which makes them likely to bleed into the vitreous, which is the clear gel that fills the middle of the eye. Bleeding inside the eye is seen as floaters or spots. Over time, scar tissue can then form on the surface of the retina and contract, leading to a retinal detachment. This is similar to wallpaper contracting and peeling away from the wall. If left untreated, retinal detachment can lead to loss of vision.

Symptoms of diabetic retinopathy:

Asymptomatic: In the early stages of mild non-proliferative diabetic retinopathy, the person will usually have no visual complaints. Therefore, it is important for people with diabetes to have a comprehensive dilated exam by their eye doctor once a year.
Floaters: This is usually from bleeding into the vitreous cavity from proliferative diabetic retinopathy.
Blurred vision: This can be the result of fluid leaking into the retina, causing diabetic macular edema.

Risk factors for diabetic retinopathy:

Blood sugar. Lower blood sugar will delay the onset and slow the progression of diabetic retinopathy. Chronically high blood sugar and the longer the duration of diabetes, the more likely chance of that person having diabetic retinopathy.
Medical conditions. People with high blood pressure and high cholesterol are at greater risk for developing diabetic retinopathy.
Ethnicity. Hispanics, African Americans and Native Americans are at greater risk for developing diabetic retinopathy.
Pregnancy. Women with diabetes could have an increased risk of developing diabetic retinopathy during pregnancy. If they already have diabetic retinopathy, it might worsen during pregnancy.

Article contributed by Jane Pan M.D.

The content of this blog cannot be reproduced or duplicated without the express written consent of Eye IQ