The term astigmatism is used to describe a cornea that isn't round.  The cornea is shaped like a football rather than a round, spherical basketball.  Like a football, the astigmatic cornea has two curves:  a steeper one, and a flatter one 90 degrees away.  These two curves bend light entering the eye, causing two images to form on the retina. 

Patients with astigmatism may notice blurred or ghost images close up or far away.  Astigmatism may be present in various degrees and is found in approximately 30 to 40% of individuals who wear glasses or contact lenses.

 A contact lens applied to a healing or compromised cornea, providing protection and allowing it to heal, while alleviating the constant rubbing of the eyelids.

For individuals over 40 who are considering refractive surgery to decrease dependence on glasses and contact lenses, clear lens replacement (CLR) is an option. In essence, this procedure entails removing the natural lens of the eye and replacing it with an intraocular lens (IOL) implant. The procedure is essentially the same as a cataract operation with lens implant, however, in this case, the procedure is completed prior to cataract development for the refractive advantage.

CLR is a procedure that is more invasive than LASIK, PRK, and SUPRALASE, with consequent greater potential risks. However, CLR may be an excellent alternative to these procedures for people already wearing bifocals or for those who do not qualify for other refractive procedures due to extremes of refractive error. Because CLR requires entering the eye to place the lens implant, the patient has a small risk of infection inside the eye (endophthalmitis) that is not present in the other, above mentioned, refractive procedures (LASIK, PRK, and SUPRALASE). Unlike these procedures, however, CLR avoids any treatment of the cornea and instead changes the refractive power of the eye in a potentially more natural position (i.e., natural lens of the eye). CLR, thus, avoids any significant risk of reduction of contrast acuity. 

Because CLR requires removal of the natural lens of the eye, the patient is subsequently unable to focus at near (accommodate). This is why CLR is best suited for patients over 40 who are already wearing bifocals. One potential solution to this problem of accommodative loss is implantation of the Array multifocal IOL implant. This implant allows focusing at both near and far, allowing most patients to read small size print and drive a car without glasses, following implantation of the lens in both eyes. A total of 41% of patients implanted with the Array multifocal lens in both eyes reported that they never wore glasses post-operatively. The drawback of this lens is that approximately 15% of patients have severe difficulty with halos and 11% have severe difficulty with glare. Less than 1% of patients have had such severe visual difficulties following implantation of the Array lens, that they have requested removal of the lens. 

A second alternative for patients who are considering CLR, but who do not embrace the notion of wearing reading glasses following surgery, is monovision. With monovision, the traditional monofocal IOL implant is inserted bilaterally, however, the patient’s dominant eye is corrected for distance and the non-dominant eye is corrected for near. This choice is also an excellent one, but not necessarily an option that would be tolerated by everyone. An excellent method to determine whether this is a viable option is to correct the eyes in monovision fashion as a trial, prior to consideration of surgery. Those patients that tolerate monovision with contact lenses (or perhaps glasses), will likely tolerate and enjoy this visual solution following surgery with lens implants. 

Conjuctivitis, commonly known as pink eye, is an infection of the conjunctiva (the outer-most layer of the eye that covers the sclera). The three most common types of conjunctivitis are: viral, allergic, and bacterial. Each requires different treatments. With the exception of the allergic type, conjunctivitis is typically contagious.

To avoid spreading infection, take these simple steps:

• Disinfect surfaces such as doorknobs and counters with diluted bleach solution.
• Don't swim (some bacteria can be spread in the water) .
• Avoid touching the face.
• Wash hands frequently.
• Don't share towels or washcloths.
• Do not reuse handkerchiefs (using a tissue is best).
• Avoid shaking hands.

The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber providing most of an eye's optical power. Together with the lens, the cornea refracts light, and as a result helps the eye to focus, accounting for approximately 80% of its production to 20% of the lens focusing power. The cornea contributes more to the total refraction than the lens does, but, whereas the curvature of the lens can be adjusted to "tune" the focus depending upon the object's distance, the curvature of the cornea is fixed.

The cornea has unmyelinated nerve endings sensitive to touch, temperature and chemicals; a touch of the cornea causes an involuntary reflex to close the eyelid. Because transparency is of prime importance the cornea does not have blood vessels; it receives nutrients via diffusion from the tear fluid at the outside and the acqueous humor at the inside and also from neurotrophins supplied by nerve fibres that innervate it. In humans, the cornea has a diameter of about 11.5 mm and a thickness of 0.5 mm - 0.6 mm in the center and 0.6 mm - 0.8 mm at the periphery.

What are the symptoms of dry eyes? 

Dry eyes can cause a gritty, sandy sensation, burning, stinging and itching. Some people notice their eyes sticking shut when they wake up. Sometimes a dry eye can actually seem watery. The eye can be producing poor quality, reflex tears, which don't do the job of keeping the eye lubricated.  

What can be done for dry eyes? 

The first line of treatment is usually artificial tears. There are several excellent brands on the market. One person may like one type better, while another may find a different brand works better. If you are using artificial tears more than 4 times/day, a non-preserved tear should be used. Ask your eye care practitioner to make some recommendations. If your eyes are severally dry, a humidifier in rooms that you spend a lot of time may be helpful. There are now also prescription drops (Restasis) that can alleviate dry eyes.  

What if the drops don't work? 

The doctors can place tiny collagen or silicone plugs in the drainage canals of your eyelids. These plugs prevent the tears from draining down and out of your eyes. Collagen plugs last about 2 weeks. Generally, they are a good first step. If the patient notices improvement for a few days, then the symptoms return, permanant silicone plugs can be inserted. While these plugs are removable if necessary, they do not dissolve on their own and don't require replacing. 

Who gets dry eyes? 

Virtually anyone is prone to dry eyes, although women get the condition more than men, and older people more often than younger people. 

What causes dry eyes? 

Various systemic diseases such as lupus, rheumatoid arthritis, or Sjögren’s Syndrome can cause dry eyes. Environmental conditions, some prescription and over the counter medications, and wearing contact lenses also contribute to dryness. 

What kind of medications cause dry eyes? 

Antihistamines, such as Benadryl, anti-depressants, and some blood pressure medications can contribute to dry eye problems. Oral contraceptives are another common culprit, as are alcohol and marijuana. There are countless other over-the-counter and prescriptions; ask your eye care practitioner about specific ones. 

Endophthalmitis is an infection inside the eye, that is, an intraocular infection. There are multiple different types of endophthalmitis, but our discussion will be limited to the most common type, post-operative endophthalmitis. This condition occurs most commonly after cataract surgery, typically afflicting approximately one in every 1,000 patients. In most cases, surgery was routine and uncomplicated, though certain surgical complications may increase the incidence of this infection. Patients typically present with a rather sudden onset of progressively worsening vision, pain, and a red eye. Most patients present the symptoms with the condition 3 to 12 days after surgery. 

The Excimer Laser is the instrument used in the majority of refractive surgical procedures.  Rather than burning or cutting material, the excimer laser adds enough energy to disrupt the molecular bonds of the surface tissue, which effectively disintegrates into the air in a tightly controlled manner through ablation rather than burning. Thus excimer lasers have the useful property that they can remove exceptionally fine layers of surface material with almost no heating or change to the remainder of the material which is left intact.

Floaters are caused by tiny bits of vitreous gel or cells that cast shadows on the retina.  Flashes occur when the vitreous tugs on the sensitive retina tissue.

Signs and Symptoms

• Black spots or "spider webs" that seem to float in the vision in a cluster or alone
• Spots that move or remain suspended in one place
• Flickering or flashing lights that are most prominent when looking at a bright background like a clear, blue sky

Symptoms that may indicate a more serious problem  

• Sudden decrease of vision along with flashes and floaters
• Veil or curtain that obstructs part or all of the vision
• Sudden increase in the number of floaters

Glaucoma is a condition that affects one or both eyes. It is associated with damage to inner parts of the eye (optic disc) and loss of vision. The amount of vision loss will depend on the severity and how long the condition has been present. We offer several glaucoma procedures to treat our patients.

What causes glaucoma?

Many factors play a role in the development of glaucoma. However, the primary factor is intraocular pressure (IOP). There is gel-like fluid inside the eye called aqueous humor. This fluid helps to shape and keep the eye healthy. It also causes a small amount of pressure inside the eye. Sometimes this pressure can get too high; this is called ocular hypertension (OH).

A person can have OH and not have any loss of vision. But over time, this high pressure can begin to damage sensitive parts of the eye. This may lead to vision loss. Once damage starts to occur, the person is said to have glaucoma.

It is important to note that glaucoma can be caused by many factors other than IOP. Some people may get glaucoma but never have a high IOP. Your doctor can help explain all the causes of glaucoma.

How is glaucoma and ocular hypertension diagnosed?

Ocular hypertension (OH) is diagnosed by actually measuring the IOP of each eye. This is done with a machine that uses a special tool to measure the pressure in your eye. Once the doctor knows what your IOP is, he/she will do an eye examination and other tests. This is to see if any loss of vision has occurred. It also will help show if there is any damage to the internal parts of the eye.

Here at First Colonial Eye Center we offer a state of the art diagnostic and monitoring tool, called an OCT, which helps our doctors to clearly see the internal structures of your eye, so problems can be treated before they progress.

The doctor will also use information about any family history of glaucoma, medicine use, and your past medical history.

Call us today to schedule your Complete Eye Exam so we can help you monitor your overall eye health.

First Colonial Eye Center: (757) 428-1005

             or APPOINTMENTS

Are there risk factors for glaucoma?

Certain factors can increase a person's risk of developing glaucoma. A few of these risk factors are:

• Age over 50.
• Very high IOP.
• Thin cornea (an outer layer of your eye).
• African Americans over age 40.
• Individuals with other health conditions, such as diabetes.

Your doctor can determine if these or other risk factors are present.

 Hyperopia, or farsightedness, occurs when images are formed behind the retina, resulting in a blurred image. This is due to an eye that is relatively too short, or the refractive powers of the cornea and lens of the eye are relatively too weak. Depending on the degree of farsightedness and the age of the individual, some farsighted people may see clearly at both distance and near through the process of accommodation, or focusing of the lens in the eye. This may cause significant eyestrain, however, accomaditive abilities are gradually lost with aging.

Implantable contact lenses, known as phakic intraocular lenses (IOLs) to ophthalmologists, are presently being investigated as another refractive procedure. Phakic IOLs hold promise as potentially powerful refractive tools with almost unlimited potential to correct refractive errors (nearsightedness and farsightedness). At the present time, however, phakic IOLs are being studied in clinical trials to determine efficacy and safety. If FDA approved, phakic IOLs are expected to gain wide acceptance from ophthalmologists who have implanted IOLs in cataract patients for the past four decades with excellent results.

The phakic IOL is unique, however, in that the thin intraocular lens implant is placed in the eye without removing the natural lens of the eye, as is completed in cataract surgery. At present, phakic IOLs are being studied which are implanted both in front of, and just behind, the iris of the eye. Given that the natural lens of the eye is not removed, the patient retains the natural focusing capability (accommodation) of the eye for near focusing tasks. 

The phakic IOL must be shown to be as accurate in correcting refractive errors as other refractive procedures (e.g., LASIK, PRK, CK, and SUPRALASE) and have a comparable safety profile prior to FDA approval. At present, data regarding the potential risks, such as cataract formation, corneal decompensation, and glaucoma, is being gathered.

Intacs is a recent and revolutionary corneal ring prescription insert that is entirely reversible. Thus, patients who elect to have Intacs are not "locked in" to the procedure forever, as are patients who undergo other refractive procedures such as LASIK and PRK.

Vision correction with Intacs entails implanting the micro-thin intracorneal rings into the cornea by a trained eye surgeon. Intacs produce a reshaping of the curvature of the cornea, reliably reducing low degrees of myopia (nearsightedness). Intacs cannot be felt by the patient, require no maintenance, and are probably less visible than a contact lens to the naked eye. Intacs have been studied for 10 years and are FDA approved. The primary drawback at the present time is that Intacs are only available in the U.S. for low degrees of myopia (-1.00 to –3.00 diopters). However, these levels of myopia account for about 54% of all myopes.

Intacs are also prescription inserts, and they can be removed or replaced if one's vision needs change or there is any dissatisfaction with the corneal ring inserts. In the U.S. clinical trials, all of the very few people who had Intacs removed could subsequently be corrected to 20/20 or better vision.

Intacs produce excellent results. In U.S. clinical studies, 97% of patients saw 20/40 or better, 74% saw 20/20 or better, and 53% saw 20/16 or better. Visual correction with Intacs is also rapid and stable. Eighty percent of patients have 20/40 or better vision the day after surgery. A year after surgery, over 50% of patients see 20/16 or better as a result of their first procedure, i.e., without enhancements.

Intraocular literally means within the eye. For example, intraocular pressure refers to pressure within the eye; an intraocular foreign body resides within the eye.  The pressure readings helps doctors study the health of your eye.  See Glaucoma.

The iris, visible through the clear cornea as the colored disc inside the eye, is a thin diaphragm composed mostly of connective tissue and smooth muscle fibers.

Keratoconus is an eye condition where the clear front of the eye, the cornea, gets thin and bulges outward into a cone shape. This usually begins in the teens or early twenties and affects mostly males. And one eye is usually worse than the other eye. It is also oftentimes familial, so alert other family members to get their eyes checked.

LASIK, an acronym for Laser-Assisted in Situ Keratomileusis, is a form of refractive laser eye surgery performed by ophthalmologists intended for correcting myopia, hyperopia, and astigmatism.

The lens or crystalline lens is a transparent, biconvex structure in the eye that, along with the cornea, helps to refract light to focus on the retina. Its function is thus similar to a man-made optical lens.

Limbal Relaxing Incisions (LRI) are truly a modification of Astigmatic Keratotomy (AK), which is a procedure to treat astigmatism. Astigmatism is present when the cornea is not spherical, i.e., it is steeper in one meridian than the opposite meridian 180 degrees away. The cornea with astigmatism may be thought of as being more football shaped rather than basketball shaped. LRI's are incisions that are placed on the far peripheral aspect of the cornea (the limbus) resulting in a cornea that is more round. The astigmatism is thus reduced and uncorrected vision is improved.  There are other options in correcting an astigmatism with the advances made in laser vision correction.  Consult your ophthalmologist to explore your options.

The treatment of hyperopia (farsightedness) with laser thermokeratoplasty (LTK) is an exciting new addition to the refractive surgical procedures that eye surgeons may now offer to patients. Over 70 million people in the U.S. alone are hyperopic and as many as 80% of those may be candidates for this procedure.  There are always new procedures that may be possible to treat hyperopia just as well.  Discuss your options with your ophthalmologist.

Many people are not aware that age-related macular degeneration, often called ARMD, is the leading cause of blindness in the world. According to the eye-health organization Prevent Blindness America, some 13 million Americans have evidence of age-related macular degeneration.

The disease breaks down the macula, the light-sensitive part of the retina responsible for the sharp, direct vision needed to read or drive. 

Macular degeneration is more common in people over age 65, and whites and females tend to get the disease more than others. Most cases of macular degeneration are related to aging, but it also can occur as a side effect of some drugs, and it appears to run in families.

Macular degeneration can produce a slow or sudden painless loss of vision. If straight lines look wavy, vision begins to seem fuzzy, or there are shadowy areas in central vision, it may indicate early signs of age-related macular degeneration.

A microkeratome is a precision surgical instrument with an oscillating blade designed for creating the corneal flap in LASIK surgery.

Myopia, or nearsightedness, is a condition of the eye in which images are formed in front of the retina, resulting in a blurred image. This occurs when the eye is relatively too long or the refractive powers of the cornea and lens of the eye are relatively too strong. 

Myopia usually begins in childhood, and progressively worsens until adulthood is achieved, usually about 18 to 21 years of age.

All people will experience difficulty reading, usually beginning in their 40s. There is a lens in the eye, which “accommodates” light so that we can see at near distances. With Presbyopia, light from a near object enters the eye, the cornea refracts the light and the lens changes shape to accommodate for the decreased focal length of a near object.  

This is exactly the same process that occurs when focusing your camera on a near object. Unfortunately this lens within the eye, as it ages, loses its ability to focus for us and we need reading glasses or bifocals.    

Presbyopia can be dealt with in a number of ways and now can be corrected through a laser vision procedure called CK, so please contact our staff to better understand your options and if this is something that you think you are experiencing. 

Call Us for your FREE Consultation

(757) 428-1005 or APPOINTMENTS

Photorefractive Keratectomy (PRK) is a procedure in which the surface of the cornea is reshaped by an ophthalmologist using an Excimer laser. PRK may be used to treat myopia (nearsightedness), hyperopia (farsightedness), or astigmatism. PRK does not involve creation of a corneal flap utilizing the microkeratome, and therefore, the protective superficial layers of the cornea must heal post-operatively. This generally means that patients who undergo PRK will require significantly more time than LASIK patients to achieve their best vision, but avoid more possible complications due to the elimination of the flap creation.

 The retina is a thin layer of neural cells that lines the back of the eyeball. It is comparable to the film in a camera.

Radial Keratotomy (RK) is a refractive procedure for myopia (nearsightedness) that has enjoyed tremendous success, but has largely been supplanted in recent years by PRK, LASIK, and now SUPRALASE. RK was performed on approximately a million Americans over a ten-year period beginning in the early 1980's. 

Supralase is a surface ablation procedure that combines an unique mathmatical formula that helps customize the procedure with a very precise pharmacological regimen to secure its pristine outcomes to treat myopia and astigmatism. 

Supralase uses a technologically advanced excimer laser that produces a cool laser beam to gently reshape the corneal surface in a precisely prescribed, individually customized treatment.  The average treatment depth equals about one third the thickness of a human hair.  The treatment which takes about 45 seconds, has been described as "watching a light show".  The healing process takes about 36 hours, and most people are able to return to work Monday following a Friday procedure.