Periodic eye exams are important for preventative eye care. There are many vision problems that have no signs or symptoms. Therefore, only an eye examination will reveal them.
You need to give a good history to determine any symptoms you may be experiencing, as well as how long you've had them. A generalized full-body health history is also very pertinent for a good history evaluation, including all medications being taken by the patient.
Eye Exams Performed at Cape Regional Eye Center, PLLC
- Visual Acuity
— Checking vision is the only accurate way of measuring visual acuity and each eye's ability to see. When you are asked to read the eye chart, your vision will be recorded like a fraction, such as 20/40. This means that the top number is how many feet from the eye chart you are being tested from and the bottom number is the smallest letter size you were able to read. A person with 20/40 vision would have to get within 20 feet of a letter that should be seen at 40 feet in order to see it clearly. A normal vision for distance is 20/20.
— Refraction is defined as a series of tests performed in arriving at a decision to see what lens or lenses will benefit your visual needs. Dr. Cape or his technicians will check your visual acuity and determine the need for prescription glasses by having you look through a phoropter (a large pair of glasses with hundreds of different lenses to determine the best for you).
— This test is what measures the amount of fluid causing pressure in the eye. Dr. Cape or his technician will apply eye drops and then use a preferred technique involving a quick puff of air or gently applying a pressure-sensitive tip near or against the eye. Normally a reading in the teens or early 20s is an acceptable pressure. This could vary depending on other eye symptoms or abnormalities.
— Dilating drops are placed in the eye to dilate or widen the pupil for examination. Usually, after a few minutes, the eyes are dilated enough for examination. Dr. Cape will use a special magnifying lens to examine your retina for any abnormalities such as damage, diabetic retinopathy or age-related macular degeneration. It also allows Dr. Cape to see the optic nerve to check for any damage you might have, such as glaucoma or inflammation of the nerve. After getting dilating drops, you will usually experience blurred, close-up vision for several hours. you will also notice that the pupil size is enlarged when looking at yourself in the mirror.
This is a surgical procedure to replace your cornea with corneal tissue from a donor. The cornea is the transparent surface of your eye that accounts for a very large part of your focusing power. A corneal transplant is also called a keratoplasty. This is done on an outpatient basis. Most corneal transplants are very successful. There is a small risk of tissue rejection of the donor cornea.
A corneal transplant is usually done for a patient that has a damaged cornea. A transplant can also relieve pain or other symptoms associated with a disease of the cornea.
Reasons for Corneal Transplants
- Corneal swelling (corneal edema)
- Keratoconus (cornea is shaped like a cone outward)
- Clouding of the cornea
- Corneal ulcers
- Complications from a previous eye surgery or injury
- Corneal thinning
- Corneal scarring
The body’s immune system sometimes rejects the donor cornea. This would be called a corneal rejection and possibly could lead to a second transplant procedure. The signs of rejection would be loss of vision, redness, tearing, sensitivity to light, or pain. About 20% of cornea transplant patients experience a rejection.
Finding a donor cornea is much easier than finding a liver or kidney donor. Most all people can donate their corneas after they die. Due to this fact, more corneas are available. The wait usually isn’t very long. Once a donor cornea becomes available, the patient would be contacted to proceed with surgery. It is done as an outpatient procedure with a sedative to make you relax and a local anesthetic to numb your eye. The damaged cornea is removed and the donor cornea is cut to fit and sutured in place. The stitches may be removed at a later date.
Following the surgery you will be prescribed eye drops to use post-operatively for several weeks. There will be a protective shield placed on your eye for protection for the first couple of days. You will be asked to return for follow up visits frequently for the first six months to one year. Most people who have a cornea transplant will have their vision at least partially restored after the surgery. You may be prescribed glasses after your transplant.
Laser equipment uses a concentrated beam of high-energy light waves through a special material to treat tissue. Laser stands for Light Amplification by Stimulated Emission of Radiation. There are different types of lasers that are used for treatment of different types of conditions. All lasers at Cape Surgery Center, LLC are handpicked by Dr. Cape and meet his very precise specifications. He only uses the latest, most state-of-the-art eye equipment.
Argon and krypton thermal lasers are lasers that heat up when the beam reaches the eye. They have several important uses:
- Open the filtration system for glaucoma
- Open the iris for treatment of narrow angle glaucoma
- Destroy abnormal tissue like a tumor
- Repairs retinal tears
- Slows or stops abnormal growth of blood vessels such as treatment for diabetic retinopathy
- Treatment of macular degeneration
- Bond the retina to the back of the eye
- Seal off blood vessels that are bleeding or leaking fluids
YAG and Excimer photodisruptive are lasers that sculpt the tissue. They are used for specialized purposes:
- Change the shape of the patient’s eye surface
- Cut thin membranes inside the eye that blocks vision.
Advantages of Ophthalmic Lasers
The advantages of using ophthalmic lasers are that there are no risks of infection from a laser light. It can be performed in an office or outpatient setting. You may go home shortly afterwards.
Laser surgery is still considered surgery. However, this surgery does not involve the use of a scalpel or knife. As with any surgical procedure, no matter how simple, all procedures could have complications. Dr. Cape will discuss the risks and benefits with you.
The retina contains all the sensory receptors for the transmission of light. The retina receptors are divided into two main parts: the rods and the cones. The rods function best in dim lighting. Cones work best under daylight conditions or brighter lighting. There are fewer cones than rods. The cones enable us to see small visual angles with good acuity. Color vision is totally dependent on the cones. Damage to the cones can severely reduce the ability to see directly ahead. Vision with rods is relatively poor. The rods are distributed mainly in the periphery of the retina (not in the macula). Damage to the rods would result in night blindness, but would not affect vision straight ahead.
Retinal detachment is a separation of the inner layer of the retina from the outer layer and the choroid. Retinal detachment occurs when the vitreous (gel substance that fills the eye cavity) begins to shrink or sag. This is a common occurrence of the aging process. Fluid starts to leak through a tear causing the retina to peel away from the underlying layer.
Warning signs would be a sudden onset of floaters or flashes of light. Surgery should be performed within a few days in order to preserve the vision. If the retina is already detached, surgery such as pneumatic retinopexy, vitrectomy, or scleral buckling may be performed. Surgery sometimes can restore vision.
Macular Degeneration (Age-Related Macular Degeneration)
Age-related macular degeneration, better known as AMD, is a chronic condition that affects people usually over the age of 50. The macula begins to deteriorate and the patient notices blurred vision or slightly distorted central vision. It appears as a blind spot in the center of vision.
Macular degeneration is classified in two categories: dry disease and wet disease. The wet disease occurs as abnormal blood vessels form as a complication of the dry disease and usually causes a rapid vision loss.
A macular hole is a small break or tear in the macula, which is the tissue near the center of the retina that is responsible for central vision. Macular holes are more common in women over 60 years of age. Holes can also occur if the vitreous gel begins to sag and shrink and then separates from the retina. It shifts, pulling on the macula. This causes a hole to begin. Signs of a hole would be slight distortion or blurriness in vision straight ahead. A blind spot develops right in the central vision as the hole gets larger.
Macular holes are repaired with surgery called a vitrectomy. A gas bubble is placed in the eye. This bubble pushes on the macula when the patient looks down, therefore, allowing the hole to heal. After surgery, the patient is required to lay in a facedown position for 10 days to two weeks. This allows the bubble to continue to press on the macula that is sealing the hole. Vision recovery could take up to three months after surgery.
This occurs when the vitreous that fills the eye sags and then pulls away from the retina. This forms a small, jagged flap on the surface. In the beginning of the retinal tear, vision is usually blurry.
Treatment is necessary to reseal the tear. This is done with either laser (creates small burns on the retina) or with cryopexy (freezing the small areas of the retina) to hold the retina to the underlying tissue to prevent a detachment. Usually, most of the vision returns after treatment.
In diabetic patients, excess glucose can cause tiny capillaries in the back of the eye to swell and leak fluid. The symptom is blurry vision. Tiny new blood vessels grow out of the retina as a part of the disease process. These blood vessels could break and bleed into the vitreous, causing further impairment of vision.
Nearly half of the diabetic population has some form of diabetic retinopathy. This complication can result in blindness.
Types of Diabetic Retinopathy
— This is the early stage of diabetic retinopathy. Symptoms usually are mild or even nonexistent. Blurred vision may occur from swelling of the retina. The swelling occurs from the damaged blood vessels that ooze fluid. You may not need treatment. Controlling your blood sugar, blood pressure, and cholesterol is very important.
- Proliferative — This is a more advanced stage of diabetic retinopathy. New and abnormal blood vessels grow on the surface of the retina or in the vitreous cavity. These vessels bleed into the vitreous which clouds or even blocks the vision. The vessels can pull on the retina, which could cause a retinal detachment. Treatment for proliferative diabetic retinopathy would be a focal laser photocoagulation. This is where lasers are used to create tiny little burns on the retina to seal off the abnormal blood vessels and stop any leakage of fluid or blood into the eye.
Ophthalmologists that perform oculoplastics procedures are better known as ophthalmic plastic Surgeons. Oculoplastics are surgical procedures that deal with the orbit (the eye socket), eyelids, face, and the tear ducts. It also includes the reconstruction of the eye and associated structures around the eye. Procedures include repair of droopy eyelids (blepharoplasty), repair or reconstruction of the tear ducts, orbital fracture repairs, removal of tumors in and around the eye, reconstruction of the eyelids and facial procedures such as eyelifts, brow lifts, facelifts, and laser skin resurfacing.
Common Plastics Procedures
— surgery of the eyelids to remove excessive skin or fat that causes eyelids to droop
— surgery to repair eyelid margins that turn outward, exposing the eye
— surgery to repair eyelid margins that turn inward, causing lashes to rub the outer surface of the eyeball
— surgery to partially sew the eyelids together to narrow the opening
- Dacryocystorhinostomy (DCR)
— surgery to restore the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct doesn’t work properly
— surgery to make an incision into the lacrimal sac trying to promote drainage
— surgery to remove the eyeball leaving the eye muscles and remaining orbital contents intact
— surgery to remove the eyes contents, leaving the scleral shell intact. This is usually done to reduce pain in a blind eye.
Dry eye syndrome is when the eye is no longer able to produce a healthy layer of tears to keep the eye moist.
Tears are made up of three layers:
Each part serves a function in protecting and nourishing the front surface of your eye. If the tears evaporate too quickly or don’t spread all the way over the eye evenly, dry eyes develop. Dry eye symptoms occur in perfectly healthy people. It is more common with older age patients because you produce fewer tears with age.
Each time you blink, a layer of tears are spread across the front surface of the eye. Tears provide lubrication, wash away foreign matter in the eye, and keep the surface of the eyes smooth and clear. Certain conditions such as arthritis or lupus cause severe dry eyes. In some cases, conditions such as stroke or Bell's palsy would make it difficult to close the eyes, therefore causing the eye to be dry from exposure and tear evaporation. When you watch television or really concentrate on something, you don’t blink often enough. This causes the eyes to dry and vision to blur.
Treatments for Dry Eyes
- Wetting drops called artificial tears
- Medications such as topical steroid drops
- Lubricating ointments used at bedtime
- Hot compresses with eyelash scrubs
- Punctal plugs placed in the tear ducts to help the tears remain on the surface of the eye longer.
Most people with dry eyes have only discomfort and occasional blurred vision, but no vision loss.