Eye Care Associates of Nevada Blog
Dry Eye Treatment Q&A: Punctal Plugs
There are multiple different symptoms for dry eye – stinging, burning, foreign body sensation, excessive tearing, redness, etc. One of the tools we use to help treat this chronic condition is through punctual plugs. This blog will highlight the use of punctal plugs – one of the various dry eye treatments we offer at Eye Care Associates of Nevada.
What are punctal plugs and how do they work?
Punctal plugs are biocompatible implants that are used to occlude the tear ducts of your eye. There are two tear ducts (upper and lower) that help drain the tears of your eye. Our tears naturally drain through the ducts to the nose before descending to the back of the throat. Patients with dry eye may have inadequate tears or excessive drainage from these ducts and may benefit from having punctual plugs. The intent behind occluding this pathway is to increase the amount of tears that rest on the surface of your eyes – thus, improving the stability of tear film and improving the health and comfort of your eyes. There is also research that demonstrates that punctual plugs may also increase the efficacy of other dry eye treatments by increasing tear volume and increasing contact time of eye drops.
Are punctal plugs permanent?
There are three main categories of punctal plugs: temporary, semi-permanent and permanent. The plugs are composed of collagen, silicone, or other polymers that are safe for the body. In many cases, we like to trial temporary plugs that dissolve within weeks to months to see if the patient benefits from their dry eye symptoms before considering a more permanent option. It is important to understand that permanent punctal plugs are reversible and may be removed at any time if there are any complications. Permanent plugs may fall out over time – your eye care physician checks for their placement at your regular dry eye follow-up exams.
What does the procedure consist of?
After the consultation to determine eligibility for punctal plugs, the insertion procedure is often scheduled at a following visit. The procedure takes less than 15 minutes. It requires finding the right size punctal plug for your tear ducts, a topical numbing drop for comfort, and the application of the plug itself. A temporary plug will not be seen externally while a permanent plug will have the flattened head of the plug resting on top of the tear duct, which may be visible with a microscope. Patients may initially have awareness of the plug, but often become accustomed to it with time.
What are some risks and benefits I should understand for punctal plugs?
There are many factors to consider before deciding to treat with punctal plugs. These include pre-existing ocular surface inflammation, systemic health issues, history of prior eye infections, allergies, etc. Please schedule an appointment with us today to see if you may benefit from this dry eye treatment.
Why are my upper eyelids drooping?
Droopy eyelids are often caused by excess skin, muscle and/or fat around the eye. As a result, the excess tissue can cause sagging of the eyebrow or eyelids. This condition is called dermatochalasis – it affects both eyes (sometimes with mild asymmetry) and is a slow process associated with aging. Note that if there are any sudden changes to your lid drooping, or if new drooping affects one eye only, this may require a more urgent eye examination. Please consult our office for additional questions or to schedule a lid evaluation.
What does the procedure consist of?
This is a surgical procedure. Therefore, it requires an examination and consultation with one of our ophthalmologists. The initial appointment is similar to a regular eye exam but also includes an assessment of your lid position as well as a peripheral (side) vision test. On surgery day, the eyelid will be prepared with numbing medications prior to the blepharoplasty procedure. You will also receive sedation to help you relax, but generally anesthesia is not required. The procedure generally takes about twenty minutes, after which you will relax in our surgery center prior to being released. You will be required to have a driver accompany you home.
How long does it take for my eyes to heal?
Generally this surgery requires a 1-day and/or 1-week follow-up. It is common to have blurry vision, watering eyes, light sensitivity, bruising of the lids, bleeding, or eye pain and discomfort during the first week. An antibiotic ointment is applied four times a day to the eyelids during this time. Typically, eyelid sutures are removed at your 1-week appointment. The bruising, bleeding, and discomfort around the eyes generally may take a few weeks to resolve.
Is this covered by insurance?
This is considered a medical procedure – so we would need to check with your medical insurance for coverage. Blepharoplasty is considered medically indicated if your lids are bothersome and meet specific vision requirements determined during the evaluation.
What about my lower lids or bags under my eyes?
We are happy to assess all lid conditions at Eye Care Associates of Nevada to determine what the best options are for your eyes. Lower lid drooping may be caused by several eye findings such as ectropion (chronic lid eversion), conjunctival chalasis (excess tissue that lines the white part of your eye), or other conditions. Some of these conditions may contribute to dryness, irritation, watering, or redness of the eyes. We do several different surgical procedures at our eye clinic to help address some of these findings – especially as they may potentially cause dry eye symptoms and put the health of the eye at risk. Some droopy lower lids or bags under eyes may require a consult with an oculoplastic surgeon. Schedule an appointment today with one of our doctors for additional questions about lid procedures.
Refractive Surgery Treatment Spotlight: LASIK vs. PRK
One of our many services at Eye Care Associates of Nevada includes refractive surgery. Refractive surgery provides visual freedom for a wide range of daily activities by reducing your dependency on glasses or contact lenses. Here are a few facts about the different surgical options.
What is LASIK? (Laser-assisted in situ keratomileusis)
LASIK is a refractive surgical procedure that can correct nearsightedness, farsightedness and astigmatism. It requires a microkeratome to create a thin flap of tissue on the front surface of the cornea, followed by excimer laser ablation which reshapes the cornea underneath to your given prescription. After the laser, the flap is gently re-positioned over the site.
LASIK advantages: The main advantage of LASIK over PRK is the maintenance of the very top layer of the surface of the eye – called the corneal epithelium. Because the central portion of the corneal epithelium stays intact, there tends to be less discomfort during the post-operative recovery period compared to PRK. This typically leads to a faster visual recovery and less time on surgical drops.
What is PRK? (Photorefractive keratectomy)
PRK is surgery that also treats nearsightedness, farsightedness, and astigmatism. It requires removal of the central corneal epithelium before reshaping the underlying cornea. Due to the removal of the top layer, it requires the eye to regenerate these superficial cells post-surgically. Some patients may report more discomfort than LASIK during the first few days after surgery. This requires daily follow-ups for the first few days to ensure proper healing as those corneal cells regenerate and connect. It also may take at least several weeks, and in some cases months, for the vision to stabilize.
PRK advantages: One benefit of PRK is the ability to operate on corneas too thin for LASIK. Another benefit over LASIK is the absence of a corneal flap. By eliminating the need for potential space created by a flap, PRK has a lower risk of infection and greater stability compared to LASIK – especially for patients with higher susceptibility to trauma (contact sports, military, etc.). Many doctors also prefer PRK for patients with dry eye. Research shows that goblet cell damage from the LASIK suction ring can cause increased dryness; in addition, disrupting corneal nerves with creating a LASIK flap may also disrupt the feedback loop for producing tears.
What is LASEK? (Laser Epithelial Keratomileusis)
LASEK is a hybrid of PRK and LASIK. Instead of creating a flap with a microkeratome (LASIK) or removal the patient’s epithelium (PRK), LASEK treats the epithelium with alcohol to loosen and separate it from the cornea and is then rolled back. The underlying stroma is ablated with a laser and the epithelial cells are rolled back and repositioned. The benefits of LASEK include reducing postoperative haze, improving time for visual recovery, and decreasing post-operative pain over traditional PRK.
Which do I choose?
A consultation with an eye care specialist at Eye Care Associates of Nevada will allow us to better choose which option to consider. After a careful analysis of your prescription, corneal shape, and other health factors, an eye doctor will provide professional recommendations based on your needs. Some patients may qualify for one procedure but not another due to various factors such as age, pupil size, thickness of the cornea, ocular diseases, presence of a cataract, etc. For more detailed information on our surgical procedures click here or schedule a refractive surgery evaluation today.
Disease Management Spotlight: Glaucoma Management
Glaucoma is a disease of the optic nerve that can potentially cause permanent loss of vision. Patients commonly hear that glaucoma is related to high eye pressure. Although it is true that we manage glaucoma often by controlling eye pressure, glaucoma itself has many different forms and causes. This blog will discuss how we manage open-angle glaucoma – the more common and chronic form of the disease. For a more detailed summary on the disease itself, click here.
What are risk factors for Open-Angle Glaucoma?
- Vascular conditions
- Race: African Americans
- Family history
- High myopia
- Optic nerve appearance
- Elevated eye pressure
- Corneal thickness
How is Open-Angle Glaucoma detected?
- Unlike other eye diseases, visual symptoms are usually not evident until the disease is advanced-stage. It affects peripheral (side vision) before any loss to central vision – this is often why the disease goes undetected by patients! Because the vision loss is irreversible, it is important to detect and treat glaucoma before significant vision loss has occurred. Our testing can help identify early patterns of glaucoma to protect your vision.
What types of tests do we do for Glaucoma testing?
- A glaucoma evaluation consists of a multitude of specialty testing to establish a baseline. Although there is no single definitive test for the disease, our subsequent visits throughout the year can monitor for any changes that are characteristic for glaucoma. Here are some of the glaucoma tests we do at Eye Care Associates:
- Dilated eye exam
- Eye pressure
- Pupil testing
- Visual Field Test (peripheral vision)
- Corneal thickness measurements
- Angle evaluation (gonioscopy)
- Optic nerve head scans – optical coherence tomography (OCT)
- Optic nerve photos
My eye doctor mentioned glaucoma at my last exam – how often should I go in for an eye exam?
- Glaucoma suspects: patients may have eyes that are suspicious for glaucoma due to certain risk factors above – but not requiring treatment at this time. These patients are followed extensively in the beginning (every 3-6 months), and if stable (non-changing), they can be seen yearly at a minimum with selected updated glaucoma testing.
- Unstable Glaucoma: every ~1-4 months. Stability requires multiple visits without worsening. Patients in this category often are recently diagnosed or have new changes to their medication/treatment plan that require a closer frequency of follow-ups to see if they are responding well to treatment. Patients with advanced-stage glaucoma are also seen in this time frame.
- Stable Glaucoma: every ~4 months to a 1 year. With stable measurements at consecutive visits, some patients may be able to seen less frequently.
Every treatment plan is different for each individual depending on the form or severity of glaucoma. For concerns or questions, please ask your doctor at your next eye appointment.
Macular degeneration is a common degenerative condition of the retina that can progress and affect central vision.
There are two main forms of AMD: dry macular degeneration, the more common form (85-90%), and wet macular degeneration (10-15%). Wet macular degeneration is likely to cause severe vision loss. Although the more severe form of the disease is less common, 10% patients per year can progress from dry to wet form.
For a more detailed summary of the disease process, click here. Here are some common questions patients have with macular degeneration:
What are risk factors for AMD?
- Age: also referred to as age-related macular degeneration as it is more common in individuals 50.
- Smoking, high blood pressure, cardiovascular disease – research shows smoking doubles the risk.
- Race: Caucasians are at higher risk than African Americans or Hispanic/Latinos
- Family history
How is AMD detected?
- Changes to your central vision.
- Dilated eye exams. It is possible that early signs of AMD may be present without changing your vision. During your dilated exam at Eye Care Associates, we carefully examine the retina for any diseases. We also have specialty photography and imaging that help detect and further manage any signs of AMD.
How often should I go in for an eye exam? How do I treat AMD?
- We recommend annual dilated eye exams to help screen for eye diseases. However, the follow-up for macular degeneration may require more frequent monitoring depending on the stage of the disease. Although there is no cure for the disease, we have ways of treating and minimizing the disease progression.
Schedule and treatment for patients with:
- Risk factors for AMD: Annual dilation to monitor for progression – UV eye protection while outside, smoking cessation
- Early AMD: Annual dilation, above treatment
- Intermediate AMD: 6-12 months depending on severity – above treatment plus self-monitoring with amsler grid, vitamin supplements to prevent progression
- Advanced AMD / Wet AMD: Likely retinal consult with 1-3 month follow-ups
For concerns or questions with macular degeneration, please ask your doctor at your next eye appointment.
There is an exciting new treatment for Dry Eye Disease (DED) at Eye Care Associates of Nevada, especially for patients with ocular rosacea. These dry eye patients have a specific underlying inflammation that is fueling the disease process. Here are some facts about this new treatment and how it can help with dry eye.
What is rosacea?
Rosacea is an inflammatory disease that causes redness of the skin; patients tend to be lighter in skin complexion, sunburn easily, and have facial flushing that worsens with alcohol consumption or spicy foods. The disease can involve skin and tissue around the eyes (ocular rosacea) – in which the inflammation may lead to meibomian gland dysfunction and a multitude of dry eye symptoms, including grittiness, scratchiness, burning, stinging, fluctuations in vision that clear with blinking, eye fatigue, or excessive tearing.
What is IPL?
Intensive Pulse Laser, or IPL, is an FDA-approved treatment for acne and rosacea that has been used in dermatology over the years. Recently, ophthalmology has discovered the therapeutic effects for helping patients with ocular rosacea to minimize the impact of dry eye disease.
How does it work?
This is an in-office medical device. A doctor or trained staff uses a flash lamp that emits specific wavelengths of light to help cauterize leaky blood vessels found in the skin’s surface. These leaky blood vessels are a primary source of inflammatory mediators to the eye, which cause redness, poor tear film stability, and discomfort. Most patients will receive four treatments 3-4 weeks apart, and occasional maintenance treatments depending on skin complexion and severity of dry eye. By cutting off the source of inflammation with IPL, the tear and oil glands can be restored to a healthy state, helping to bring stability to the patient’s tear film and overall enhanced comfort of their eyes.
What are the side effects?
The short-term side effects include slight redness and tenderness – similar to sunburn. This will require sunscreen protection for 1-2 weeks post-treatment. The long-term effects include a reduction of leaky blood vessels that ultimately leads to overall less surface redness. There are also cosmetic changes around the treated areas. The treatment tightens up the collagen in the skin around the eyes, which may reduce wrinkles. There are also some reports of darker sunspots being removed due to treatment. Dermatologists have been using this as a cosmetic procedure for many years due to these benefits!
I’m currently using other medications for dry eye – do I still continue other dry eye therapy with IPL treatment?
Your eye doctor will recommend which treatments to use before and after this procedure. Patients who continue with their dry eye therapy will often notice an enhanced therapeutic response after the IPL sessions due to a different mechanism of action. Despite the complexity and multiple factors involved with dry eye disease, there are compounding benefits to treatment if prescribed strategically. Ask your doctor at Eye Care Associates of Nevada for any additional questions on IPL and dry eye treatment.