Archives: Treatments

Ptosis

Ptosis is when the upper eyelid droops over the eye. The eyelid may droop just a little, or so much that it covers the pupil (the black dot at the center of your eye that lets light in). Ptosis can limit or even completely block normal vision.Children and adults can have ptosis. Fortunately, this condition can be treated to improve vision as well as appearance.

Ptosis in children

Children born with ptosis have what is called congenital ptosis. This can be caused by problems with the muscle that lifts the eyelid (called the levator muscle).
The most obvious sign of ptosis is a drooping eyelid. Another sign is when the upper eyelid creases do not line up evenly with each other. A child with ptosis may tip their head back, lift up their chin, or raise their eyebrows to try to see better. Over time, these movements can cause head and neck problems.
Sometimes, a child born with ptosis can also have other eye-related problems. They can include eye movement issues, eye muscle disease, tumors (on the eyelid or elsewhere) and other problems.
Having ptosis puts a child at risk for vision problems. If the child’s eyelid droops so much that it blocks vision, amblyopia (also called “lazy eye”) can develop. One eye will have better vision than the other. A child with ptosis can also have astigmatism, where they see blurry images. The child may also develop misaligned (crossed) eyes.

Ptosis in adults

Adults get ptosis (called involutional ptosis) when the levator muscle stretches or separates away from their eyelid. This can be caused by aging or an eye injury. Sometimes ptosis happens as a side effect after certain eye surgery. Rarely, diseases or tumors can affect the eyelid muscle, causing ptosis.
Your ophthalmologist will find the cause of your ptosis in order to recommend treatment. They will do a complete eye exam, and may also want you to have blood tests, X-rays, or other tests. The ophthalmologist will likely recommend surgery to help the eyelid muscle work better.

Ptosis treatment for children

Ophthalmologists consider the following factors when deciding the best way to treat ptosis in children:

• The child’s age
• Whether one or both eyelids are involved
• The eyelid height
• The strength of the eyelid’s muscle
• The eye’s movements
• In most cases, ophthalmologists recommend surgery to treat ptosis in children. This is to either tighten the levator muscle or attach the eyelid to other muscles that can help lift the eyelid. The goal is to improve vision.
• If the child also has amblyopia, that condition must be treated as well. Amblyopia may be treated by wearing an eye patch or special eyeglasses, or using certain eye drops, to strengthen the weaker eye.
• All children with ptosis—whether or not they have surgery—should see their ophthalmologist regularly for eye exams. Ask your child’s ophthalmologist how often exams are needed. Because kids’ eyes grow and change shape, they need to be checked for amblyopia, refractive disorders, and other eye problems.

Adult ptosis surgery

• Ptosis surgery is done as an outpatient procedure in your ophthalmologist’s office. A local anesthesia will be used to numb your eye and the area around it.
• Sometimes, the surgeon may only need to make a small adjustment to the lid’s lifting muscle. Extra skin from the eyelid also may be removed to help the eyelid lift properly. For more severe ptosis, the levator muscle may need to be strengthened and reattached to the eyelid.
• As with any type of surgery, there are possible risks and complications with ptosis repair. Your ophthalmologist will discuss these with you.
• Before eyelid surgery, be sure to tell your ophthalmologist about all the medicines you take. Include all prescription and over-the-counter medications, vitamins, and supplements. It is important for your eye surgeon to know if you take aspirin (or aspirin-containing drugs) or blood thinners, or if you have a bleeding problem

Nasolacrimal duct obstruction

What is a tear duct obstruction?

• Tears normally drain through small openings in the corners of the upper and lower eyelids called puncta and enter the nose through the nasolacrimal duct. Tear duct obstruction prevents tears from draining through this system normally [See figure 1]. If the tear duct is blocked, there will be backflow of tears and discharge from the eye.

What causes nasolacrimal duct obstruction in children?

• The most common cause is the failure of a membrane at the end of the tear duct (valve of Hasner) to open normally at or near the time of birth. Other causes of blocked tear ducts in children include:
• Absent puncta (upper and/or lower eyelids)
• Narrow tear duct system
• Infection
• Nasal bone that blocks the tear duct entering the nose.

How common is nasolacrimal duct obstruction?

• Over 5% of infants have symptoms of nasolacrimal duct obstruction affecting one or both eyes. Most (approximately 90%) clear spontaneously during the first year of life.

What are the signs/symptoms of tear duct obstruction?

• Blockage of the drainage system causes tears to well up on the surface of the eye and overflow onto the eyelashes, eyelids, and down the cheek. This usually occurs within the first days or weeks of life.
• The eyelids can become red and swollen (sometimes stuck together) with yellowish-green discharge when normal eyelid bacteria are not properly “flushed” down the obstructed system. Severe cases result in a serious infection of the tear duct system (dacryocystitis).

Can a tear duct obstruct intermittently?

• The severity of the signs can vary under different conditions such as upper respiratory illnesses (“colds” or nasal congestion) or outdoor exposure such as wind or cold. If a child has cold, he or she may have increased tearing or discharge.

How is tear duct obstruction diagnosed?

• A history of tearing and discharge at a very early age is strongly suggestive of a blocked tear duct. An ophthalmologist is able to perform certain tests in the office to confirm the diagnosis. It is important that the eyes be examined for uncommon but important other causes of tearing in infants including childhood glaucoma.

What is the treatment of a blocked tear duct?

• Fortunately, tear duct obstruction resolves spontaneously in a high percentage of cases. When obstruction is persistent, one or more of the following treatments may be recommended: tear duct massage, topical antibiotic eye drops, tear duct probing, balloon tear duct dilation, and/or tear duct intubation.

How does tear duct massage work?

• Tear duct massage can be performed at home to help the tear duct open. A pediatric ophthalmologist or primary care physician can demonstrate the most effective massage technique.

When should topical antibiotics be used?

• Antibiotic eye drops or ointment may be used to treat discharge or mattering around the eye. The medication does not open the blocked tear duct and symptoms often recur when the eye drops are discontinued.

When should tear duct probing be performed?

• If the tear duct remains blocked after one year of age, a nasolacrimal duct probing may be performed.

How does tear duct probing work?

• A smooth probe (resembling a thin straight wire) is gently passed through the tear duct and into the nose. Using probes of progressively larger diameters can widen a tear duct system.

What type of anaesthesia is used for tear duct probing?

• Some younger children have a tear duct probing done in the office using topical anaesthetic drops. Older children usually have a brief general anaesthetic in an outpatient surgery setting. Sometimes a tube (stent) is placed in the nasolacrimal system while a child is asleep to prevent recurrence of tearing.

How successful is tear duct probing?

• Tear duct probing is generally very successful. Additional procedures with enhancements are sometimes necessary. In some cases, a more involved operation may be needed to open the tear duct system (dacryocystorhinostomy, DCR).

Entropion & Ectropion

Entropion

Entropion (inversion of an eyelid) is caused by age-related tissue relaxation, postinfectious changes (particularlytrachoma), posttraumatic changes, or blepharospasm. Eyelashes rub against the eyeball and may lead to corneal ulceration and scarring. Symptoms can include foreign body sensation, tearing, and red eye. Diagnosis is clinical. Definitive treatment is surgery.

Ectropion

Ectropion (eversion of the lower eyelid) is caused by age-related tissue relaxation, cranial nerve VII palsy, and posttraumatic or postsurgical changes. Symptoms are tearing (due to poor drainage of tears through the nasolacrimal system, which may no longer contact the eyeball) and symptoms of dry eyes. Diagnosis is clinical. Symptomatic treatment can include tear supplements and, at night, ocular lubricants; definitive treatment is surgery.

We provide a full spectrum of management of diseases affecting the posterior segment of the globe including the treatment of diseases and conditions such as retinal detachment, diabetic retinopathy, vascular occlusive disease, age-related macular degeneration, macular holes, & ocular inflammation.

What is Diabetic Retinopathy?

People with diabetes can have an eye disease called diabetic retinopathy. This is when high blood sugar levels cause damage to blood vessels in the retina. These blood vessels can swell and leak. Or they can close, stopping blood from passing through. Sometimes abnormal new blood vessels grow on the retina. All of these changes can steal your vision.

Stages of diabetic eye disease

There are two main stages of diabetic eye disease.

NPDR (non-proliferative diabetic retinopathy)

This is the early stage of diabetic eye disease. Many people with diabetes have it.

AMD is very common. It is a leading cause of vision loss in people 50 years or older.

Two types of AMD

Dry AMD

This form is quite common. About 80% (8 out of 10) people who have AMD have the dry form. Dry AMD is when parts of the macula get thinner with age and tiny clumps of protein called drusen grow. You slowly lose central vision. There is no way to treat dry AMD yet.

Wet AMD

This form is less common but much more serious. Wet AMD is when new, abnormal blood vessels grow under the retina. These vessels may leak blood or other fluids, causing scarring of the macula. You lose vision faster with wet AMD than with dry AMD.
Many people don’t realize they have AMD until their vision is very blurry. This is why it is important to have regular visits to an ophthalmologist. He or she can look for early signs of AMD before you have any vision problems.

What is a Retinal Detachment?

The retina is the light-sensitive tissue lining the back of our eye. Light rays are focused onto the retina through our cornea, pupil and lens. The retina converts the light rays into impulses that travel through the optic nerve to our brain, where they are interpreted as the images we see. A healthy, intact retina is key to clear vision.
The middle of our eye is filled with a clear gel called vitreous (vi-tree-us) that is attached to the retina. Sometimes tiny clumps of gel or cells inside the vitreous will cast shadows on the retina, and you may sometimes see small dots, specks, strings or clouds moving in your field of vision. These are called floaters. You can often see them when looking at a plain, light background, like a blank wall or blue sky.

As we get older, the vitreous may shrink and pull on the retina. When this happens, you may notice what look like flashing lights, lightning streaks or the sensation of seeing “stars.” These are called flashes.

Retinal tear and retinal detachment

Usually, the vitreous moves away from the retina without causing problems. But sometimes the vitreous pulls hard enough to tear the retina in one or more places. Fluid may pass through a retinal tear, lifting the retina off the back of the eye — much as wallpaper can peel off a wall. When the retina is pulled away from the back of the eye like this, it is called a retinal detachment.
The retina does not work when it is detached and vision becomes blurry. A retinal detachment is a very serious problem that almost always causes blindness unless it is treated with detached retina surgery.

The Nicholson Eye Clinic offers primary care of common children’s eye problems as well as comprehensive evaluations, inpatient consultations, and follow-up for children with simple or complex eye and/or vision disorders. Children presenting with amblyopia, strabismus, inherited eye disease, and other eye conditions receive not only short-term treatment of the immediate problem, but also long-term rehabilitative care and monitoring of their visual development.
Particular emphasis is placed on state-of-the-art diagnosis and treatment as well as comprehensive follow-up, including monitoring vision development, preventing amblyopia, fitting special pediatric aphakic contact lenses, and pediatric intraocular lens implantation.

Our strabismus patients, both children and adults, receive comprehensive diagnosis and management of their ocular misalignment and diplopia (double vision.

We provide comprehensive diagnostic testing, including a thorough eye exam, measuring visual acuity, pupil reactivity, color vision, side vision and ocular alignment. We also conduct computerized visual field testing.
Treatment will depend on your diagnosis but could include medical therapies, botulinum toxin injections to stop muscle spasm for disorders, such as hemifacial spasm, and surgical treatments, such as eye muscle surgery to restore straight eye alignment, and laser surgery for a number of vision disorders. Many of the surgical procedures can be done in an outpatient setting, without an overnight stay in the hospital.

We treat the scope of vision problems/disorders that are associated with the brain, including:

• Reduced vision
• Blind spots
• Double vision
• Abnormalities of the pupils
• Droopy eyelids
• Abnormal alignment of the eyes
• Abnormal eye movements
• Vision loss from stroke or tumor
• Optic neuritis – inflammation of the optic nerve
• Thyroid eye disease
• Optic atrophy – the loss of some or most of the nerve fibers in the optic nerve
• Ischemic optic neuropathy – optic neuropathy from obstruction of blood vessels
• Ocular myasthenia gravis – an autoimmune disorder that causes weakened eye muscles
• Focal dystonias – movement disorders that affect the eyes and face, including hemifacial spasm and blepharospasm

At the Nicholson Eye Clinic we evaluate and treat glaucoma and other diseases characterized by increased intraocular pressure and/or glaucomatous optic atrophy. Diagnostic modalities include computerized visual field testing, gonioscopy & tonometry. Treatment may consist of laser therapy or incisional surgery, alone or in combination with medical therapy.

Glaucoma Surgeries

Glaucoma can be treated with eye drops, pills, laser surgery, traditional surgery or a combination of these methods. The goal of any treatment is to prevent loss of vision, as vision loss from glaucoma is irreversible. The good news is that glaucoma can be managed if detected early, and that with medical and/or surgical treatment, most people with glaucoma will not lose their sight.

Taking medications regularly, as prescribed, is crucial to preventing vision-threatening damage. That is why it is important for you to discuss side effects with your doctor. While every drug has some potential side effects, it is important to note that many patients experience no side effects at all. You and your doctor need to work as a team in the battle against glaucoma. Your doctor has many options. They include:

Eye Drops

It is important to take your medications regularly and exactly as prescribed if you are to control your eye pressure. Since eye drops are absorbed into the bloodstream, tell your doctor about all medications you are currently taking. Ask your doctor and/or pharmacist if the medications you are taking together are safe. Some drugs can be dangerous when mixed with other medications. To minimize absorption into the bloodstream and maximize the amount of drug absorbed in the eye, close your eye for one to two minutes after administering the drops and press your index finger lightly against the inferior nasal corner of your eyelid to close the tear duct which drains into the nose. While almost all eye drops may cause an uncomfortable burning or stinging sensation at first, the discomfort should last for only a few seconds.

Pills

Sometimes, when eye drops don’t sufficiently control IOP, pills may be prescribed in addition to drops. These pills, which have more systemic side effects than drops, also serve to turn down the eye’s faucet and lessen the production of fluid. These medications are usually taken from two to four times daily. It is important to share this information with all your other doctors so they can prescribe medications for you which will not cause potentially dangerous interactions.

Surgical Procedures

When medications do not achieve the desired results, or have intolerable side effects, your ophthalmologist may suggest surgery.

Laser Surgery

Laser surgery has become increasingly popular as an intermediate step between drugs and traditional surgery though the long-term success rates are variable. The most common type performed for open-angle glaucoma is called trabeculoplasty. This procedure takes between 10 and 15 minutes, is painless, and can be performed in either a doctor’s office or an outpatient facility. The laser beam (a high energy light beam) is focused upon the eye’s drain. Contrary to what many people think, the laser does not bum a hole through the eye. Instead, the eye’s drainage system is changed in very subtle ways so that aqueous fluid is able to pass more easily out of the drain, thus lowering IOP.

You may go home and resume your normal activities following surgery. Your doctor will likely check your IOP one to two hours following laser surgery. After this procedure, many patients respond well enough to be able to avoid or delay surgery. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, many patients are eventually able to discontinue some of their medications. This, however, is not true in all cases. Your doctor is the best judge of determining whether or not you will still need medication. Complications from laser are minimal, which is why this procedure has become increasingly popular and some centers are recommending the use of laser before drops in some patients.

Argon Laser Trabeculoplasty (ALT) — for open-angle glaucoma

The laser treats the trabecular meshwork of the eye, increasing the drainage outflow, thereby lowering the IOP. In many cases, medication will still be needed. Usually, half the trabecular meshwork is treated first. If necessary, the other half can be treated as a separate procedure. This method decreases the risk of increased pressure following surgery. Argon laser trabeculoplasty has successfully lowered eye pressure in up to 75 percent of patients treated. This type of laser can be performed only two to three times in each eye over a lifetime.

Selective Laser Trabeculoplasty (SLT) — for open-angle glaucoma

SLT is a newer laser that uses very low levels of energy. It is termed “selective” since it leaves portions of the trabecular meshwork intact. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated. Some authors have reported that a second repeat application of SLT or SLT after prior ALT is effective at lowering IOP.

Laser Peripheral Iridotomy (LPI) — for angle-closure glaucoma

This procedure is used to make an opening through the iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This allows the fluid to bypass its normal route. LPI is the preferred method for managing a wide variety of angle-closure glaucomas that have some degree of pupillary blockage. This laser is most often used to treat an anatomically narrow angle and prevent angle-closure glaucoma attacks.

Cycloablation

Two laser procedures for open-angle glaucoma involve reducing the amount of aqueous humor in the eye by destroying part of the ciliary body, which produces the fluid. These treatments are usually reserved for use in eyes that either have elevated IOP after having failed other more traditional treatments, including filtering surgery, or those in which filtering surgery is not possible or advisable due to the shape or other features of the eye. Transscleral cyclophotocoagulation uses a laser to direct energy through the outer sclera of the eye to reach and destroy portions of the ciliary processes, without causing damage to the overlying tissues. With endoscopic cyclophotocoagulation (ECP), the instrument is placed inside the eye through a surgical incision, so that the laser energy is applied directly to the ciliary body tissue.

Traditional Surgery

Trabeculectomy

When medications and laser therapies do not adequately lower eye pressure, doctors may recommend conventional surgery. The most common of these operations is called a trabeculectomy, which is used in both open-angle and closed-angle glaucomas. In this procedure, the surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A flap is created that allows fluid to escape, but which does not deflate the eyeball. A small bubble of fluid called a “bleb” often forms over the opening on the surface of the eye, which is a sign that fluid is draining out into the space between the sclera and conjunctiva. Occasionally, the surgically created drainage hole begins to close and the IOP rises again. This happens because the body tries to heal the new opening, as if it was an injury. Many surgeons perform trabeculectomy with an anti-fibrotic agent that is placed on the eye during surgery and reduces such scarring during the healing period. The most common anti-fibrotic agent is Mitomycin-C. Another is 5-Fluorouracil, or 5-FU.

About 50 percent of patients no longer require glaucoma medications after surgery for a significant length of time. Thirty-five to 40 percent of those who still need medication have better control of their IOP. A trabeculectomy is usually an outpatient procedure. The number of post-operative visits to the doctor varies, and some activities, such as driving, reading, bending and heavy lifting must be limited for two to four weeks after surgery.

Drainage Implant Surgery

Several different devices have been developed to aid the drainage of aqueous humor out of the anterior chamber and lower IOP. All of these drainage devices share a similar design which consists of a small silicone tube that extends into the anterior chamber of the eye. The tube is connected to one or more plates, which are sutured to the surface of the eye, usually not visible. Fluid is collected on the plate and then absorbed by the tissues in the eye. This type of surgery is thought to lower IOP less than trabeculectomy but is preferred in patients whose IOP cannot be controlled with traditional surgery or who have previous scarring.

Nonpenetrating Surgery

Newer nonpenetrating glaucoma surgery, which does not enter the anterior chamber of the eye, shows great promise in minimizing postoperative complications and lowering the risk for infection. However, such surgery often requires a greater surgical acument and generally does not lower IOP as much as trabeculectomy. Furthermore, long term studies are needed to assess these procedures and to determine their role in the clinical management of glaucoma patients.

Some Promising Surgical Alternatives

The ExPress mini glaucoma shunt is a stainless steel device that is inserted into the anterior chamber of the eye and placed under a scleral flap. It lowers IOP by diverting aqueous humor from the anterior chamber. The ExPress offers the glaucoma surgeon an alternative to either repeating a trabeculectomy or placing a more extensive silicone tube shunt in those patients whose IOP is higher than the optic nerve can tolerate.

The Trabectome is a new probe-like device that is inserted into the anterior chamber through the cornea. The procedure uses a small probe that opens the eye’s drainage system through a tiny incision and delivers thermal energy to the trabecular meshwork, reducing resistance to outflow of aqueous humor and, as a result, lowering IOP.

Canaloplasty, a recent advancement in non-penetrating surgery, is designed to improve the aqueous circulation through the trabecular outflow process, thereby reducing IOP. Unlike traditional trabeculectomy, which creates a small hole in the eye to allow fluid to drain out, canaloplasty has been compared to an ocular version of angioplasty, in which the physician uses an extremely fine catheter to clear the drainage canal.

A refractive error is the second major cause of visual impairment. Despite that it can be corrected simply by a pair of spectacles, millions remain blind or visually impaired due to uncorrected refractive error.

Uncorrected refractive error remains largely unaddressed – this is contributed to by a complicated web of barriers.

The cornea and lens of your eye helps you focus. Refractive errors are vision problems that happen when the shape of the eye keeps you from focusing well. The cause could be the length of the eyeball (longer or shorter), changes in the shape of the cornea, or aging of the lens.

Four common refractive errors are

• Myopia, or nearsightedness – clear vision close up but blurry in the distance
• Hyperopia, or farsightedness – clear vision in the distance but blurry close up
• Presbyopia – inability to focus close up as a result of aging
• Astigmatism – focus problems caused by the cornea

The most common symptom is blurred vision. Other symptoms may include double vision, haziness, glare or halos around bright lights, squinting, headaches, or eye strain.

Glasses or contact lenses can usually correct refractive errors. Laser eye surgery may also be a possibility. Refractiv surgery includes phakic intraocular lenses (implantable contact lenses), LASIK (laser-assisted in situ keratomileusis). Other options in refractive surgery include LASEK (laser epithelial keratomileusis), PRK(photorefractive keratectomy) & PTK (phototherapeutic Keratectomy).

Fund out what the difference between LASIK and PRK is?

The Nicholson Eye Clinic helps evaluate and treat diseases of the cornea and epithelium, including dystrophies, infections, corneal swelling, dry eyes and Keratoconus.

What is keratoconus?

Keratoconus is a condition of the eye in which the structure of the cornea (the clear outer part of the eye)is not strong enough to hold its round shape, causing it to bulge outwards like a cone. Often, this condition is hereditary and occurs more frequently in people with certain medical problems.Progression of the outward corneal bulging can happen very quickly or can occur over several years, though these changes can stop at any time.

How Will Keratoconus Affect My Vision?

Keratoconus will change vision in two ways:

• Irregular astigmatism results as the smooth surface of the cornea becomes slightly wavy
• Nearsightedness develops as the front of the cornea expand

Symptoms

• Sudden change of vision in just one eye
• Double vision in just one eye
• Bright lights with halos around them
• Light streaking
• Seeing triple ghost images

The treatment is in the form of a surgical procedure called Collagen cross linking.

Collagen Cross Linking

What is Collagen crosslinking ?

The corneal collagen is crosslinked with the help of ultraviolet rays ( UVA ) and a photosensitiser, Riboflavin , thus enhancing the rigidity of corneal tissue and stabilizing the condition

Who is a suitable candidate for Collagen crosslinking ?

Patient must be a proven case of keratoconus with documented progression of the disease.
Patient’s corneal thickness must be at least 400 microns.
Patient should not be pregnant or nursing.

How is Collagen crosslinking performed ?

The treatment is performed under topical anaesthesia with the patient in a lying down posture in the sterile environment of the operating room. The patient’s corneal epithelium is gently removed, following which Riboflavin solution is applied every 5 minutes for the first half an hour. Thereafter the patient’s cornea is exposed to UVA light for half an hour. The treatment is painless and lasts for an hour, at the end of which the eye is patched.

The cornea is the clear, transparent dome in front of the “black portion” of the eye. It is also the main focusing surface, which converges light rays as they enter the eye to focus on the retina. It is thus the most important part of the optical apparatus of the Eye. Loss of transparency directly results in loss of vision.

When can the patient resume normal routine ?

A foreign body sensation, irritation or watering accompanied by pain is not uncommon on the day of treatment. Analgesics for relief from pain will be prescribed , and the pain usually subsides within 24 hours. Dryness of the eyes frequently follows this treatment and may last for 6 to 8 months. Tear lubricants are therefore recommended for the period.

Concerns using UVA light

UVA light can potentially harm the vital cell layer of the cornea known as the endothelium as also the crystalline lens and the retina. However, the use of riboflavin and the choice of the wavelength of UV light used, substantially reduces the intraocular penetration of UV rays to negligible levels. Potential side effects are therefore avoided. It is mandatory to perform a preoperative measurement of the corneal thickness and to exclude patients with corneal thickness less than 400 microns .
The 3 & 5 year results of the Dresden clinical study on collagen crosslinking in human eyes has shown arrest of progression of keratoconus in all treated eyes Collagen crosslinking has thus emerged as a safe and effective , inexpensive non surgical promising new treatment for Keratoconus to slow the progression of the disease and to delay or avoid corneal graft surgery. With more long term experience in the arena, prophylactic treatment of Keratoconus might become possible with collagen cross linking.

Inside our eyes, we have a natural lens. The lens bends (refracts) light rays that come into the eye to help us see. The lens should be clear, like the top lens in the illustration.

Vision problems with cataracts

If you have a cataract, your lens has become cloudy, like the bottom lens in the illustration. It is like looking through a foggy or dusty car windshield. Things look blurry, hazy or less colourful with a cataract.

What Are the Symptoms of Cataracts?

Most age-related cataracts develop gradually. As a result, you may not notice signs or changes in your vision right away when cataracts first develop.
Cataract symptom progression
Here are some vision changes you may notice if you have a cataract:

• Having blurry vision
• Seeing double (when you see two images instead of one)
• Being extra sensitive to light
• Having trouble seeing well at night, or needing more light when you read
• Seeing bright colors as faded or yellow instead

Cataract as part of aging

Though there are other risk factors for cataracts, aging is the most common cause. This is due to normal eye changes that happen after around age 40. That is when normal proteins in the lens start to break down. This is what causes the lens to get cloudy. People over age 60 usually start to have some clouding of their lenses. However, vision problems may not happen until years later.

Most age-related cataracts develop gradually. Other cataracts can develop more quickly, such as those in younger people or those in people with diabetes. Doctors cannot predict how quickly a person’s cataract will develop.

Who Is at Risk for Cataracts?

Besides aging, other cataract risk factors include: having parents, brothers, sisters, or other family members who have cataracts having certain medical problems, such as diabetes having had an eye injury, eye surgery, or radiation treatments on your upper body having spent a lot of time in the sun, especially without sunglasses that protect your eyes from damaging ultraviolet (UV) rays If you have any of these risk factors for cataract, you should schedule an appointment with your ophthalmologist.

Cataract Surgery

Cataract surgery is an operation to remove your eye’s lens when it is cloudy. The purpose of your lens is to bend (refract) light rays that come into the eye to help you see. Your own lens should be clear, but with a cataract it is cloudy. Having a cataract can be like looking through a foggy or dusty car windshield. Things may look blurry, hazy or less colorful. The only way to remove a cataract is with surgery. Your ophthalmologist will recommend removing a cataract when it keeps you from doing things you want or need to do. During cataract surgery, your cloudy natural lens is removed and replaced with a clear artificial lens. That lens is called an intraocular lens (IOL). Your ophthalmologist will talk with you about IOLs and how they work.

What to expect with cataract surgery
Before surgery:

Your ophthalmologist will measure your eye to set the proper focusing power for your IOL. Also, you will be asked about any medicines you take. You might be asked not to take some of these medicines before surgery.
You may be prescribed eyedrop medicines to start before surgery. These medicines help prevent infection and reduce swelling during and after surgery.

The day of surgery:

Your ophthalmologist may ask you not to eat any solid food at least 6 hours before your surgery.

Here is what will happen: Your eye will be numbed with eye drops or with an injection around the eye. You may also be given a medicine to help you relax. You will be awake during surgery. You may see light and movement during the procedure, but you will not see what the doctor is doing to your eye. Your surgeon will enter into the eye through tiny incisions (cuts, created by laser or a blade) near the edge of your cornea (the clear covering on the front of your eye). The surgeon uses these incisions to reach the lens in your eye. Using very small instruments, he or she will break up the lens with the cataract and remove it. Then your new lens is inserted into place. Usually your surgeon will not need to stitch the incisions closed. These “self sealing” incisions eventually will close by themselves over time. A shield will be placed over your eye to protect it while you heal from surgery. You will rest in a recovery area for about 15–30 minutes. Then you will be ready to go home.

Cataract Surgery Recovery

• Days or weeks after surgery:
• You will have to use eye drops after surgery. Be sure to follow your doctor’s directions for using these drops.
• Avoid getting soap or water directly in the eye.
• Do not rub or press on your eye. Your ophthalmologist may ask you to wear eyeglasses or a shield to protect your eye.
• You will need to wear a protective eye shield when you sleep.
• Your ophthalmologist will talk with you about how active you can be soon after surgery. He or she will tell you
• when you can safely exercise, drive or do other activities again.
• Your vision could become cloudy or blurry weeks, months or years after cataract surgery. This is not unusual. If
• you notice cloudy vision again, you might need to have a laser procedure. Called a posterior capsulotomy, this procedure helps restore clear vision.

What are the risks of cataract surgery?

• Like any surgery, cataract surgery carries risks of problems or complications. Here are some of those risks:
• Eye infection.
• Bleeding in the eye.
• Ongoing swelling of the front of the eye or inside of the eye.
• Swelling of the retina (the nerve layer at the back of your eye).
• Detached retina (when the retina lifts up from the back of the eye).
• Damage to other parts of your eye.
• Pain that does not get better with over-the-counter medicine.
• Vision loss.
• The IOL implant may become dislocated, moving out of position.
• Your ophthalmologist will talk with you about the risks and benefits of cataract surgery.

IOL Implants: Lens Replacement After Cataracts

An intraocular lens (or IOL) is a tiny, artificial lens for the eye. It replaces the eye’s natural lens that is removed during cataract surgery.
The lens bends (refracts) light rays that enter the eye, helping you to see. Your lens should be clear. But if you have a cataract, your lens has become cloudy. Things look blurry, hazy or less colorful with a cataract. Cataract surgery removes this cloudy lens and replaces it with a clear IOL to improve your vision.

IOLs come in different focusing powers, just like prescription eyeglasses or contact lenses. Your ophthalmologist will measure the length of your eye and the curve of your cornea. These measurements are used to set your IOLs focusing power.

What are IOLs made of?

Most IOLs are made of silicone or acrylic. They are also coated with a special material to help protect your eyes from the sun’s harmful ultraviolet (UV) rays.

Monofocal IOLs

The most common type of lens used with cataract surgery is called a monofocal IOL. It has one focusing distance. It is set to focus for up close, medium range or distance vision. Most people have them set for clear distance vision. Then they wear eyeglasses for reading or close work.

Some IOLs have different focusing powers within the same lens. These are called multifocal and accommodative lenses. These IOLs reduce your dependence on glasses by giving you clear vision for more than one set distance.

Multifocal IOLs

These IOLs provide both distance and near focus at the same time. The lens has different zones set at different powers. It is designed so that your brain learns to select the right focus automatically.

Toric IOLs

For people with astigmatism, there is an IOL called a toric lens. Astigmatism is a refractive error caused by an uneven curve in your cornea or lens. The toric lens is designed to correct that refractive error.

As you plan for your cataract surgery, talk to your ophthalmologist about your vision needs and expectations. He or she will explain IOL options for you in more detail.

We provide evaluation and fitting of cosmetic contact lenses that correct fornearsightedness (myopia),farsightedness (hyperopia), andastigmatism. Our doctors also can recommend new options in soft and rigid lenses forpresbyopia. Contact lenses also have therapeutic uses, and contacts for a medical diagnosis are prescribed as well. Some examples include contacts following injury or corneal transplantation, contacts with artificial iris, and contacts for eye conditions such askeratoconus and aphakia.

The Nicholson Eye clinic and Hospital provides both routine and urgent eye care serviecs. We provide primary eye care, including evaluation and treatment of cataracts, and screening and management for patients with diabetes or glaucoma.