Eye Care Associates of Nevada Blog
Kallie Kappes OD
Though some patients may prefer to have better distance vision after cataract surgery and utilize reading glasses, we encounter many patients that prefer just the opposite.
What if I have always used glasses to see far away, but I like taking my glasses off to read?
This situation is very common in patients that have been nearsighted for many years. These patients will have a prescription to clear up their far away vision, and find it much easier to take off their glasses for reading material up close. Often times, patients in situations such as this will not need glasses for performing many tasks throughout the day, and will only rely on glasses for driving, or perhaps watching television. If this is a comfortable modality, having your vision focused similarly after cataract surgery is a very successful option, and oftentimes only requires a standard lens implant. Patients will then rely on distance glasses after surgery much like before, but not rely on reading glasses for up close activities.
I’ve heard about monovision from a friend, what is it?
Monovision can be a very successful strategy for patients who would like to be less reliant on distance AND reading glasses. For this to happen, the focus of one eye is corrected for far away, allowing clear distance vision, while the other eye is focused for improved near vision at a set distance. We often encounter patients that have utilized monovision in contact lenses and have been very successful. This allows you to have more freedom from glasses but does not mean that glasses won’t always be needed.
How will I know if I can tolerate monovision?
For patients who have been successful with monovision in the past, this generally translates favorably for monovision incorporated into cataract surgery. For patients interested in monovision with no prior experience, we are often able to coordinate a trial with contact lenses before surgery.
Are there cons with selecting monovision?
Monovision allows less reliance on glasses for patients but does not mean that glasses won’t be necessary for certain situations. In situations of night driving or long-distance driving, many patients prefer having good distance vision in both eyes, and this can be achieved with a pair of glasses or contact lenses. Monovision can also compromise depth perception more so for up close tasks, and for patients who regularly perform task that require good depth perception at close distances this is something to consider.
If I have astigmatism, how does that work with monovision?
At the time of your evaluation, measurements performed on your eyes can determine if you have an astigmatism that would be significant for your vision. For patients selecting monovision, it is optimal to have any significant astigmatism corrected with a premium lens implant, especially for the distance focused eye.
Kallie Kappes OD
Will I need glasses after cataract surgery?
Cataract surgery is one of the most commonly performed surgeries performed yearly, with approximately 26 million cataract surgeries performed in 2017 alone. Advances in technology have allowed for our patients to become less reliant on spectacle or contact lens correction after the procedure. The opportunity to transition from relying on glasses or contact lenses full time to part time or even less is a very exciting opportunity but involves a lot of considerations.
How will I know if I’ll need glasses again after surgery?
At your evaluation several measurements are taken to provide your surgeon with information regarding the type of lens implants that can replace your cataracts. Farsightedness, nearsightedness as well as the presence of any astigmatism will be included in the conversation with your doctor. For patients who have only cataracts and are fortunate to be free of other eyes disease, there are great options to significantly decrease your dependency on any glasses after surgery. Your candidacy for these premium options will be determined during your evaluation.
“I would like to have good far away vision to drive and watch tv, but will I need reading glasses?”
Many patients like to be as independent as possible from glasses for distance activities such as watching TV and driving. In this case, your surgeon can select a single focus lens implant to focus your eyes for the distance. This will result in needing reading glasses for any activities that require fine detail within arm’s reach. Over-the-counter reading glasses are a suitable solution for many patients. Bifocals or progressives can also be fit to assist for near tasks after your eyes have healed from surgery.
“I have astigmatism correction in my glasses, how does that work with surgery?”
If astigmatism is present in the measurements at the time of your evaluation, the standard, single focus lens implant will not correct for astigmatism. Depending on the amount of astigmatism present, there could be a need for glasses or contacts. These would provide the best clarity when looking at distance targets i.e. driving, sporting events, tv/movie viewing, and would also be incorporated into any reading glasses prescription. In the vast majority of cases, prescribed glasses prior to cataract surgery will no longer be accurate afterwards. A new glasses prescription can be determined by your primary care eye doctor after surgery.
“I have astigmatism and I want to be independent of glasses in the distance. I don’t mind having reading glasses”
For patients who have astigmatism, a premium lens implant option is available to correct your vision for the distance thereby reducing your dependency on glasses after surgery. Patients will still require reading glasses though. These premium lens implants that correct for astigmatism are called toric lens implants. Our surgeons at Eye Care Associates of Nevada take pride in their ability to correct for astigmatism using these lenses. Our surgeons use state-of-the-art technology during surgery to ensure that the perfect toric lens implant is provided to you!
*astigmatism: when the front surface of your eye isn’t perfectly round like a sphere, but instead has more curvature in certain areas than others, which can cause distortion and blurry vision
**progressive: a type of spectacle lenses that can incorporate a distance prescription at the top part of the lens and then gradually increases in power as the eyes looks through to the bottom portion of the lens to help focus near vision
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.