Medical Procedures

Cataracts

cataractA cataract is a common condition that causes a gradual clouding and yellowing of the eye’s natural lens and affects millions of people each year, including more than half of all Americans over the age of 65.

Cataracts cause a progressive painless reduction in vision. Symptoms can include blurriness of vision, loss of color brightness, double vision, halos around lights – especially at night, daytime glare or photosensitivity, needing more light to read and frequent changes in eyeglass or contact lens prescriptions.

Risk factors include eye injury, diabetes, smoking, steroid use and exposure to UV radiation.

When cataracts begin to affect a patient’s lifestyle and quality of life, a small surgery can be performed to remove the cataract and place an artificial intraocular lens in its place, thereby restoring vision.

Cataract surgery is the most commonly performed surgical procedure in the United States and can be performed quickly and easily with a success rate of 98% or higher and a minimal risk of complications.

With each complete dilated eye exam, Dr. Stancey or Dr. Davis can determine the impact a cataract has on vision and can give a recommendation for or against surgical treatment.

Glaucoma

Glaucoma is one of the leading causes of blindness and visual impairment in the United States and can affect patients of all ages, many of who do not experience any symptoms and may not be aware that they have the disease. Glaucoma actually refers to a group of diseases that cause damage to the optic nerve, usually as a result of increased pressure within the eye. Glaucoma is usually painless and produces no symptoms until significant vision loss has occurred.

There are two main types of glaucoma, angle-closure and open-angle. Angle-closure glaucoma involves a sudden buildup of pressure in the eye and poor drainage because the angle between the iris and the cornea is too narrow. Open-angle glaucoma is the most common type of glaucoma and involves fluid in the eye not draining properly from inside the eye.

Angle-closure can develop after many years without causing pain or other noticeable symptoms, so you may not experience vision loss until the disease has progressed. This makes it difficult for many patients to know if they have glaucoma. As glaucoma progresses, patients may experience a loss of peripheral or side vision, along with sudden eye pain, headache, blurred
vision or the appearance of halos around lights. This is considered an emergency and patients must seek medical attention immediately to prevent blindness.

If Dr. Stancey or Dr. Davis determine you have narrow-angles or angle-closure, they may recommend a laser procedure to reduce your risk of glaucomatous vision loss. Click here to read more about the laser procedure. If you have cataracts, surgery to remove them may also be recommended as this increases the space inside the eye to open the angle. Click here to read more about cataract surgery.Image result for glaucoma

Risk factors for angle-closure glaucoma include:

  • Over the age of 60
  • Asian or Indian descent
  • Female
  • Family history of narrow-angles or angle-closure
  • Being far-sighted (hyperopic)

Open-angle glaucoma occurs in 90% of glaucoma patients and is thought to be due to a diseased drainage system called the trabecular meshwork. While some patients may experience symptoms from glaucoma as the disease progresses, others do not learn they have the condition until they undergo a routine eye exam. There are several different exams performed to diagnoseglaucoma cupping glaucoma, including a visual field test to check peripheral vision and an OCT (optical coherence tomography) to access the health of the optic nerve fibers. Tonometry is performed to measure the pressure inside the eye. Other tests may also be performed, such as pachymetry to measure the thickness of the cornea, which influences the measurement of the true
pressure in the eye, and gonioscopy, which uses a lens to visualize the angle and trabecular meshwork.

Once glaucoma has been diagnosed, treatment should begin as soon as possible to help minimize the risk of permanent vision loss. There is no cure for glaucoma, so treatment focuses on relieving symptoms and preventing further damage from occurring. Most cases of glaucoma can be treated with eye drops to help lower the eye pressure. Sometimes, laser or surgery is necessary. The best treatment for your individual case depends on the type and severity of the disease, and can be discussed with Dr. Stancey or Dr. Davis.

While anyone can develop open-angle glaucoma, common risk factors include:

Glaucoma Vision
Glaucoma Vision
  • Over the age of 60
  • African Americans over the age of 40
  • Family history of glaucoma – especially in a primary relative
  • Diabetes
  • Being near-sighted (myopic)
  • Steroid use (oral, inhaled, injected, or over-the-counter nasal sprays)
  • Trauma

In the past, ophthalmologists believed that glaucoma could only occur when the intraocular pressure (IOP) was >21 mmHg. However, we now know that glaucoma can occur even in patients with seemingly normal IOP. These patients have what’s called normal tension glaucoma, which is a form of open-angle glaucoma. There is some thought that low blood pressure especially at night or dysregulation of the vascular (blood system) is to blame.
Image result for optic disc hemorrhage glaucoma

Additional risk factors for normal tension glaucoma include:

  • Female
  • History of migraines
  • Raynaud’s phenomenon
  • Optic disc hemorrhages (shown at right)
  • Low systemic blood pressure or high diastolic blood pressure

Other types of glaucoma include congenital glaucoma, which develops in newborns due to an abnormal drainage system, pigmentary glaucoma, which results from increased pigment cells that block the drainage system, pseudoexfoliation glaucoma, which results from a protein-like material that blocks the drainage system, neovascular glaucoma due to systemic issues like diabetes or ocular issues such as vein occlusion, and traumatic glaucoma which results from physical trauma to the eye, among many other types.

You may be diagnosed as a glaucoma suspect if your optic nerve appears suspicious for glaucoma but does not yet meet criteria for glaucoma. Glaucoma suspects should have a comprehensive dilated exam with necessary testing at least every year to ensure it hasn’t progressed to glaucoma.

Excellent information can be found at:
The Glaucoma Research Foundation
The American Academy of Ophthalmology
The International Glaucoma Association

Flashes and Floaters

Floaters are dots, strands, webs or irregular shapes in the field of vision that move around as we move our eyes. They commonly occur as a result of age-related changes to the jelly of the eye, the vitreous. When we are born, the vitreous is firmly attached to the retina and is a thick substance without much movement. As we age, the vitreous becomes thinner and more watery and pulls away from the retina to cause little shadows we see as floaters. These spots are most visible when looking at a white or bright background.

Flashes may accompany floaters when they first develop as the vitreous is applying pressure to the retina when it pulls away.

In most cases, flashes and floaters are of no consequence and do not require treatment. Rarely though, a small hole or tear develops in the retina as the vitreous is pulling away. This can result in a retinal detachment. A dilated examination is necessary with new floaters or flashes to ensure no further treatment is necessary.

Retinal Detachment

A retinal detachment is a separation of the layers of the retina, the film in the back of the eye that transmits messages to our brain. These can occur spontaneously or with trauma. Patients with a high amount of nearsightedness are at an increased risk. The retina cannot function when the layers are separated, and without prompt treatment, permanent vision loss may occur.

Patients with retinal detachment may experience a blind spot, blurred vision or a veil or shadow forming in their peripheral vision. Other symptoms may include an increase in or new flashes and floaters. It is important to see your doctor at the first sign of symptoms in order to minimize the damage caused by this condition.

To prevent permanent vision loss, the retina must be quickly reattached. Treatment for retinal detachment can be done through laser or surgery. These procedures can preserve vision and may also allow lost vision to return in some patients. The sooner the retina is attached, the more effective treatment tends to be. If you are experiencing signs of retinal detachment, please call us immediately.

Macular Degeneration

macularThe macula is a part of the retina in the back of the eye that ensures that our central vision is clear and sharp. Age-related macular degeneration (AMD) occurs when the arteries that nourish the retina harden. Deprived of nutrients, the retinal tissues begin to weaken and die, causing vision loss. Patients may experience anything from a blurry, gray or distorted area to a blind spot in the center of vision.

AMD is the number-one cause of vision loss in the U.S. Macular degeneration doesn’t cause total blindness because it doesn’t affect the peripheral vision. Possible risk factors include genetics, age, diet, smoking and sunlight exposure. Regular eye exams are highly recommended to detect macular degeneration early and prevent permanent vision loss.

Example of Macular Degeneration
Example of Macular Degeneration

Symptoms of macular degeneration include

  • A gradual loss of ability to see objects clearly
  • A gradual loss of color vision
  • Distorted or blurry vision
  • A dark or empty area appearing in the center of vision

There are two kinds of AMD: wet (neovascular/exudative) and dry (non-neovascular). Wet AMD occurs only in about 10-15% of people with AMD. “Neovascular” means “new vessels.” Accordingly, wet AMD occurs when new blood vessels grow into the retina as the eye attempts to compensate for the blocked arteries. These new vessels are very fragile, and often leak blood and fluid between the layers of the retina. Not only does this leakage distort vision, but when the blood dries, scar tissue forms on the retina as well. This creates a dark spot in the patient’s vision.

Dry AMD is much more common than wet AMD. Patients with this type of macular degeneration do not experience new vessel growth. Instead, symptoms include thinning of the retina, loss of retinal pigment and the formation of small, round particles inside the retina called drusen. Vision loss with dry AMD is slower and often less severe than with wet AMD.

Dr. Stancey or Dr. Davis may give you an Amsler Grid at your appointment. You should monitor your vision at least once a week using your glasses, covering one eye at a time. You should monitor for new areas of vision loss or if the lines are wavy or distorted. Please call us if you notice new changes.

Recent developments in ophthalmology allow doctors to treat many patients with early-stage AMD with the help of lasers and medication. If you are a smoker, please quit, as this can increase the risk of AMD progression. Eye vitamins (see below) have been proven to benefit patients with moderate to advanced AMD. Eating green leafy vegetables and foods high in omega 3 fatty acids such as salmon, tuna and walnuts may reduce your risk of progression as well.  Lutein and zeaxanthin are natural carotenoids in the retina and can be found in colorful foods, such as kale, oranges and egg yolks. These compounds have antioxidant properties and have been found to increase the density of pigment in the macula.

Vitamins for Healthy Eyes

vitaminsAlthough our bodies receive vitamins and minerals from the foods we eat, many of us do not receive enough. As we age, our eyes become more and more susceptible to certain conditions, and may require extra protection. The Age Related Eye Disease Study (AREDS) showed that certain antioxidants can help slow moderate and advanced macular degeneration. Eye vitamins typically include:

  • Vitamin A
  • Vitamin C
  • Vitamin E
  • Vitamin B2
  • Zinc
  • Lutein

Eye vitamins can be purchased without a prescription in most cases. Dr. Stancey will help you decide which vitamins are right for you and how often you should take them after a comprehensive review of your condition.

Diabetic Eye Exams

Patients with diabetes are at an increased risk of developing eye diseases that can lead to vision loss and blindness, such as diabetic retinopathy, cataracts and glaucoma. In fact, diabetes is actually the leading cause of blindness in the United States.

Diabetic eye conditions often develop without any noticeable vision loss or pain, so significant damage may already be done to the eye by the time the patients notices any symptoms. For this reason, it is important for diabetic patients to have their eyes examined at least once a year. Early detection of eye disease can help prevent permanent damage.

Diabetic-related eye problems develop from high blood sugar levels, which can cause damage to blood vessels in the eye. Over 40 percent of diabetic patients will develop some form of eye disease in their life. The risk of developing eye problems can be reduced through regular eye exams and by keeping blood sugar levels under control through a healthy diet and regular exercise.

Diabetic eye conditions develop in the retina as a result of microvascular abnormalities. The tiny blood vessels within the retina develop microaneurysms and begin to leak blood. As new blood vessels develop, they also leak blood and can cause hemorrhages and permanent damage to the retina.

Diabetic retinopathy is the most common type of diabetic eye disease and the leading cause of blindness in the US. This condition is caused by blood vessel changes within the retina that lead to swelling and leaking of fluid. It can also cause growth of abnormal new blood vessels on the surface of the retina. There are four stages of diabetic retinopathy that begin with the occurrence of microaneurysms and eventually lead to abnormal blood vessels on the surface of the retina that can easily leak fluid and cause severe vision loss and even blindness.

The fluid can also leak into the center of the macula and cause swelling and blurred vision, a condition known as macular edema. The risk of developing macular edema increases as diabetic retinopathy progresses.

Treatment for early stages of diabetic retinopathy and other conditions usually focuses on maintaining levels of blood sugar, blood pressure and blood cholesterol, in order to prevent any permanent damage from occurring. For more advanced stages of the condition, laser surgery is often effective in shrinking the abnormal blood vessels.

Macular edema can also be treated through a laser procedure, called focal laser treatment, which places hundreds of laser burns in the area of retinal leakage to reduce the amount of fluid in the retina.

Dr. Stancey refers patients that require laser treatment for diabetic retinopathy to a retina specialist. It is important for patients to realize that these procedures cannot cure diabetic eye conditions, but rather help reduce vision loss for patients with advanced cases of the condition.

Allergic Eyes

allergicEye allergies are a common condition that affects up to 50 million Americans. In central Texas, allergic eye disease, or allergic conjunctivitis, is a fact of life. Symptoms can include redness, tearing, itching, puffiness and sometime light sensitivity. These can impair a patient’s vision or affect their overall quality of life.

The allergy may be seasonal (such as cedar or oak season) or occur throughout the year as a result of exposure to allergens such as dust mites, mold or animal dander Less frequently, patients develop allergies from wearing hard or soft contact lenses.

Allergic eye disease is uncomfortable, but it rarely causes injury. Treatment varies depending on the course, history, and symptoms and may include cold compresses, topical or oral antihistamines, mast cell stabilizers or topical corticosteroids.

Dr. Stancey or Dr. Davis can evaluate if your allergies are affecting your eyes and give recommendations on which treatment can be used to alleviate your symptoms.

Dry Eyes

dryeyesDry Eye is one of the most common findings in patients. Dry eyes can be a debilitating problem, causing pain, burning, itching, tearing and a decrease in vision. The eyes may become dry and irritated because the tear glands don’t produce enough tears or because the tears produced have a chemical imbalance and are of the wrong type.

People usually experience dry eye symptoms as they age, but certain medications or conditions can also cause this condition.

Non-surgical treatments for dry eye include increasing humidity at home or work, directing the air conditioning vent away from your face in the car, using artificial tears or moisturizing ointment or increasing more normal tear production with prescription drops. If these methods fail, small punctal plugs may be inserted at the corner of the eyes to limit tear drainage. Eyelid surgery is also a solution if an eyelid condition is causing the dry eyes.

With new treatments and contact lens materials, even contact lens wearers can find relief from dry eyes!

Blepharitis

Blepharitis is a common condition that describes inflammation of the eyelashes. Debris or inflammatory material from the lashes can enter the eye and contribute to dry eye issues. Symptoms are similar to dry eye, plus matting or crusting of the lashes, especially in the morning. Blepharitis can also lead to frequent styes. Just like teeth need to be brushed, your eyelids should be cleaned as well.

Treatment includes warm compresses and/or baby shampoo scrubs. Examples of warm compresses are warm towels or a clean sock filled with rice briefly put in the microwave. Test the warm compress on your inner wrist; if it is too hot for your wrist, it is too hot for your eye. You can gently massage the lid with the compress, keep it on the eye until it cools, and repeat as needed. To create a lid scrub, place a small amount of baby shampoo in your palm and mix it with about the same amount of water. Gently scrub your lashes daily with the mixture when you’re in the shower or washing your face. Use artificial tears throughout the day as needed. If your symptoms fail to improve antibiotic ointment or oral antibiotics may be used. There is no cure for blepharitis, so routine maintenance is key.

Stye/Chalazion

A stye or chalazion is a blocked oil gland in the margin of the eyelid. While they do not usually lead to any serious complication, they can cause pain, swelling and tearing. They can become quite large and sometimes even get infected requiring oral antibiotics.

The most common treatment is warm compresses to help open the blocked pore, but sometimes a small surgical procedure needs to be performed in the office to help drain the backed up oils. Patients with recurring styes can be placed on medicine to help prevent their recurrence.

Healthy Eye Exams

healthyeyeexamRegular eye exams are an invaluable tool in maintaining eye health by detecting and preventing disease. Early detection of eye diseases can allow for a choice of treatment options and reduced risk of permanent damage.
At Lakeway Eye Physicians and Surgeons, a comprehensive dilated eye exam is performed on every new patient to evaluate the overall health of the eyes. This is also performed on a one to two year basis depending on the patient’s age and underlying conditions.

Common Eye Conditions

The most common eye conditions diagnosed during a comprehensive eye exam involve refractive errors that cause blurry vision for patients. These conditions affect millions of people in the US and often get progressively worse as the patient ages. Fortunately, refractive errors can be easily treated to let patients enjoy clear vision at all distances.

  • Nearsightedness, or myopia, is a vision condition in which nearby objects are clear and distant objects appear blurry. This may be caused by excess corneal curvature or an oblong rather than a spherical shape to the eye, both of which affect the way light is bent upon entering the eye and whether or not it focuses properly on the retina. Myopia affects nearly one-third of all people in the US to some degree, with symptoms usually appearing before the age of 20. Patients with myopia have difficulty focusing on objects in the distance, such as a chalkboard or TV.
  • Farsightedness, or hyperopia, is a condition in which the eye focuses on distant objects better than on objects closer to the eye, so nearby objects appear blurry. This happens when light rays refract, or bend, incorrectly in the eye. The eye is designed to focus images directly on the surface of the retina, but when the cornea is incorrectly curved light rays focus behind the surface, producing a blurry image.
  • Astigmatism is a deviation of the curvature of the cornea from a perfect sphere, like a baseball, to one that is slightly pointed, like a football. As a result, light isn’t focused properly onto the retina and the patient’s vision is blurry. It’s just another reason many of us need glasses. In addition to blurry vision, patients with astigmatism may also experience headaches, eye strain and fatigue. The severity of symptoms depends on the degree of astigmatism in the eyes.

All of these vision conditions can be effectively corrected through eyeglasses and contact lenses. We offer patients a wide selection of eyeglasses, frames, lenses and contact lenses in our Optical shop.

If you are interested in learning more about any of our medical eye procedures, call 512-402-9919 today to schedule an appointment.