Eye Diseases

Cataract Surgery

A Cataract is a slowly progressive clouding or darkening of the lens within the eye, which gradually reduces vision over a period of months to several years. Usually the onset is in one's 60's or 70's, but people as young as 20 can develop adult onset cataracts, and some babies are born with cataracts. Cataract surgery is recommended when vision begins to decline, which can manifest itself as blurring with reading or glare with night driving or driving in the rain. Surgery is on an outpatient basis, with the hospital stay only about 3 hours. Surgery is done under local anesthesia in most cases, in a pleasant, comfortable environment, and usually with visual improvement occurring shortly following surgery, though total recovery may require from a few days to weeks. The goal of the surgery is to remove the cloudy native lens and replace it with a plastic lens implant. Currently there are no laser techniques for cataract surgery, though laser research is ongoing. Windham Eye Group surgeons operate at the modern, state of the art operating suite at Windham Hospital using the most advanced equipment and techniques, such as the Alcon Legacy phacoemulsification unit and small incision surgery, with foldable lenses including the latest refractive implants, including Restore, often enable patients to see without needing glasses post-operatively. All the surgeons are very experienced and extremely well trained in nationally recognized University-based programs. Our emphasis is on patient comfort and the highest quality surgical outcome.

Glaucoma

Glaucoma is a painless, progressive loss of vision, usually occurring over the course of many years, due either to high eye pressure or a lack of blood flow to the optic nerve. The loss of vision starts on the sides of the visual field and gradually moves to the center of the vision. Since it is gradual and painless, people do not realize that they are going blind. However, glaucoma is treatable by medications, laser and, in rare cases, surgery. If glaucoma is diagnosed in time, permanent visual loss may be avoided, which is why yearly eye examinations are so important, especially for African Americans, people with a family history of glaucoma, diabetics and anyone over the age of 55. Diagnosis of glaucoma requires measurement of eye pressure (which is measured at all exams) in conjunction with examination of the optic nerve appearance, and possible photos of the nerve, visual field testing and use of a retinal nerve fiber analyzer, which detects earliest optic nerve damage. Your eye exam at Windham Eye Group is complete, including a check for the presence of glaucoma. If it is detected, you will be told what steps need to be taken. All your questions will be answered and all testing and treatment can be done at our office.

Laser Treatment of Diabetic Retinopathy

Most visual loss can be prevented if the diabetic retinal disease is detected early enough for laser surgery. Laser surgery is done to treat two conditions that occur after several years of diabetes: macular edema and proliferative diabetic retinopathy. Macular edema, which causes visual loss through swelling of the retina due to fluid leakage from damaged capillaries, is treated by selective laser delivery to points of leakage in the macula, or central retina. Proliferative retinopathy, which is characterized by uncontrolled growth of fragile, hemorrhaging new blood vessels, is treated by blanketing the peripheral retina with a dense pattern of laser spots.

Photographs of the retina and a special study called a Fluorescein Angiogram, can find areas of capillary leakage and abnormal blood vessel growth. The Fluoroscein Angiogram is done by injecting a small amount of harmless dye into an arm vein, then photographing the retina with colored light. The dye fluoresces and shows the location of damaged and leaking blood vessels in the retina.

Prior to the laser, topical anesthesia, or, more rarely, injection of a local anesthetic is given. During the procedure, the fully alert patient sits at a device which gives a magnified view of the retina and also delivers laser pulses to the retina through a special contact lens.

In the case of macular edema, or fluid in the retina, the leaking blood vessels are identified by Fluorescein Angiogram. Laser is then used to directly treat these leaky vessels in order to seal them and prevent further visual loss. The initial treatment is usually accomplished in one session, but may need to be repeated in time.

In the case of proliferative diabetic retinopathy, the laser beam is directed into the eye and creates laser burns a fraction of a millimeter in size in an even pattern across the peripheral retina, avoiding the center where the visual image is formed. This treatment, called panretinal photocoagulation, causes the abnormal blood vessels to shrink and eventually disappear.

Contact Lenses

Contact lenses are fit and prescribed by our contact lens specialist who has great skill and years of experience in this field. In addition to having a basic eye exam, during the appointment, you will learn techniques for placement of the lenses on the eyes and for cleaning and care of the lenses. If you have an interest in special bifocal contact lenses, or if you are a hard (RGP) lens wearer, you can get these special lenses fit as well. Daily throwaway lenses and colored lenses are also offered. No matter which lens you select, rest assured that the health of your precious eyes is of paramount importance and will be emphasized during the evaluation and fitting.

Macular Degeneration

About 25% of people 65 and an estimated 60-75% of people over 80 develop an aging condition in their central vision called macular degeneration. There is no known cure or prevention for this at this time, but research promises breakthroughs in the not too distant future. There are two forms, dry and wet. The most common form is dry, in which there is a buildup of debris from dying cells and other matter in the central part of the retina called the macula. There is also loss of an important retinal layer called the retinal pigment epithelial layer. These two progressive changes can decrease and blur our central vision, so that it becomes increasingly difficult to read, watch TV and drive. In wet macular degeneration, there is development of new blood vessels under the retina, which are fragile and bleed, causing sudden loss of central vision and a black spot in the center of our visual acuity. If the disease is caught in time, sometimes a laser can be effective (in wet macular degeneration only) in either improving the vision, or at least, slowing the progression of the visual loss, but Avastin injections may also be helpful. Some experts recommend a diet rich in dark green leafy vegetables like spinach, parsley, kale and mustard greens and red fruits like plums and grapes. Others recommend lowering blood pressure, eating a low fat diet, exercising and maintaining a good weight. There are many vitamin companies that are promoting high doses of vitamins for this condition, but again results of research is conflicting and it is clear that high doses of some of these nutrients can actually be harmful, especially if you have ever smoked cigarettes. The best advice if you have this disease is to see your Windham Eye Group Ophthalmologist or Optometrist yearly and discuss your eye health with him or her.

Dry Eyes

The lacrimal gland, located underneath the upper eyelid, constantly produces a small amount of tears that serves to moisten and lubricate the eye's surface. We also have accessory collections of cells along the inside of our lids, which supplement the lacrimal gland's secretions. These two gland types produce the baseline tears that keep our eyes moist and comfortable. There is another type of tear secretion that occurs when we stub our toe or watch a sad movie. As we age, the cells that produce the baseline tears begin to die, and our eyes get progressively drier. It is especially problematic in women as they go through menopause, and in individuals who take certain medications, for example, diuretics for high blood pressure, allergy medications, and some medications for anxiety. Some diseases, like Sjogren's Syndrome, Rheumatoid Arthritis and thyroid disease called Grave's Disease, are also associated with dry eyes. The symptoms of dry eye are sandy, itchy, burning eye irritation, tearing when out in wind and a feeling that something is in the eye, called a "foreign body sensation". Treatments for dry eyes include putting moisture back into the environment with steam showers and humidifiers, cutting down on air conditioners, avoiding hot air heat, using tear supplements that can be purchased over the counter, putting the car blowers towards the floor and not the face, and avoiding outdoor activities when it is windy. Your Windham Eye Group Ophthalmologist or Optometrist can recommend good tear brands for your use. Your Windham Eye Group Ophthalmologist can also offer the use of very tiny artificial plugs to close the "drain pipes" in the eyelids, so that your own precious natural tears are not running out of your eye. The insertion of these plugs is quick, painless, and can be done in the office in about 5 minutes. It is usually covered by insurance. In more severe dry eyes, other treatment, including certain types of surgery, may be necessary.

Blepharospasm

Blinking is a natural, protective reflex that preserves our eyes from flying debris, and moistens and cleanses the cornea. It is important to preservation of eye health. However, in certain conditions, there is excessive blinking that can progress to such a point that the eyes are difficult to keep open and vision is impaired. This is called Benign Essential Blepharospasm. Continued blinking of this nature can actually loosen the eyelid structures and cause sagging of the lid skin called dermatochalasis, and even pull down the brow and forehead skin, called brow droop. Blepharospasm can occur on one or both sides of the face, involving not only the muscles around the eyes but also those of the cheek or around the mouth and even down the neck, in frequent, tick-like spasms. Until 1989, there was no good treatment. However, in that year, the FDA approved the use of occulinum, a medication that is a toxin in large amounts, but in small amounts, carefully calibrated by the manufacturer, it temporarily blocks the muscles from getting signals from the nerves and therefore stops the muscle spasm. The usual treatment involves nearly painless injections in the superficial skin around the eye or the involved facial muscles on an approximately every 4 month schedule. Since this condition is so debilitating, insurance usually covers this treatment. Recently, occulinum has been used for other conditions, including tension headaches. Of course, many people have heard of Botox, another name for this medication, which is used to decrease wrinkles for cosmetic purposes. Insurance does not pay for cosmetic uses. Some people get slight dry eye for a week or so after the treatment and occasionally there is an over-reaction, such that the lid droops after the injection for a week or so. These are rare and not usually severe. Most people consider the treatment a blessing and cannot think of being without it. Dr. Kaufold has been well-trained in this area and would be happy to evaluate anyone with the condition of blepharospasm, to see if they are candidates for occulinum treatments.

Lid And Eyebrow Droop

Gravity is not always our friend. It gradually pulls down facial tissue loosened and slowly becoming lax with the aging process. On occasion, this tissue excess begins to impact our side vision and becomes a hazard for driving and other activities, where seeing to the side is imperative. If there is sufficient impact on vision, Medicare will cover surgical intervention to lift the brow to its former placement, and to remove excess skin of the upper eyelid for improvement of side vision. This is called brow lift and blepharoplasty. It is done in a sterile environment and is not painful to undergo and there is little discomfort postoperatively. Ice and ointment are applied the first couple days. The sutures dissolve on their own. For a brow lift, there can be a pink line and a small dent where the sutures were. There can be bruising for a week to two afterward. The discoloration slowly fades. Make up can cover it. Individuals who smoke are not good candidates because of poor healing. Aspirin, and any nonsteroidal anti-inflammatory medication like Motrin must be stopped at least two weeks before the surgery. Individuals who use coumadin must discuss when to stop this blood thinner before surgery. Other than bleeding and infection, the major side effects of the surgery are dry eyes. A careful discussion and exam prior to surgery will minimize the risk of any unwanted results. The Ophthalmologists at Windham Eye Group are very experienced and offer this surgery.