Gainesville Ophthamology

Over time the thin skin overlying the eyelids has a tendency to droop. When the drooping eyelid skin begins to override the eyelid margin the condition is known as dermatochalasis. Dermatochalasis can cause eye irritation and impaired vision in the upper visual field. To correct dermatochalasis, an in-office procedure called blepharoplasty can be done. Blepharoplasty consists of excising the excess eyelid skin to restore normal eyelid anatomy and improve the superior visual field. Many insurance providers will cover blepharoplasty if a documented visual field improvement is expected after the procedure, as determined by preoperative testing.

When the eye’s natural lens becomes darker and cloudier over time it is known as a cataract. When a cataract becomes visually significant, the definitive treatment is to surgically remove the cataract and to put an implant in its place that allows for clear vision. Cataract surgery is a same-day surgery, and there are several options for anesthesia. The choice of anesthesia is based on surgeon recommendations, the patient’s overall health and patient preference. During surgery the cataract is broken into small pieces with ultrasound power called phacoemulsification and removed from the eye. An implant specifically calculated for each patient is then placed in the eye. There are different options for the type of implant to be placed. The standard implant covered by most insurance companies is a monofocal implant that aims to get a patient’s distance vision as clear as possible without glasses. Patients with a monofocal implant usually need glasses to see intermediate targets like the computer, and for reading. Postoperatively, patients are put on eye drops to aid in the healing process and are on activity restrictions to allow the eye to heal. After about one month most patients are healed completely and able to resume all normal activities. In the vast majority of cases, cataract surgery is highly successful and patients enjoy improved vision after the procedure.

A chalazion is a blocked oil gland of the eyelid. Although most chalazia will resolve in time, resolution may take months or even years. Surgical procedures that can be done for a chalazion include an intralesional steroid injection, or an incision and drainage of the chalazion. An intralesional steroid injection involves injection of an anti-inflammatory steroid directly into the chalazion. This procedure has good success for small or medium-sized chalazion. In the case of a large or persistent chalazion, the chalazion can be incised and the contents of the chalazion drained. This is an in-office procedure done under local anesthesia.

A comprehensive eye exam entails a thorough check of the ocular structures, evaluation of vision and screening for diseases like glaucoma and macular degeneration. Vision is checked and a glasses prescription is determined, if one is needed. An overview of a patient’s medications and systemic medical conditions is done. The patient’s eye pressure is checked. An important part of a comprehensive eye exam is dilation of the patient’s eyes, in which drops are given which cause the pupils to become enlarged. This allows the examiner to view the posterior portion of the eye, and helps to be determine if conditions like cataracts, glaucoma or macular degeneration are present. A pediatric comprehensive eye exam includes the above, but special attention is given to the movement and position of the eyes. In the pediatric population, refractive error is often determined using retinoscopy. Retinoscopy is a technique that allows the examiner to figure out what power of glasses a child needs without having to rely on their feedback with a refraction. Comprehensive eye exams are generally recommended every 1-3 years, although some conditions require closer follow up.

Contact lenses can be used to treat many refractive conditions including myopia, hyperopia, presbyopia and astigmatism. There are many different types of contact lenses including soft contact lenses, rigid gas permeable lenses, hybrid lenses, multifocal lenses and daily disposable lenses. Our office has extensive experience with contact lens fittings and is able to take the time to find a contact lens that is suitable for a patient’s refractive condition and lifestyle.

Diabetes is a systemic disease that can affect the eye. In severe cases, diabetes damage to the eye can cause permanent loss of vision. In most cases, early diabetes damage to the eye can be identified and treated before permanent vision loss occurs. Routine dilated eye exams are an important part of diabetes management for both insulin-dependent and non insulin-dependent diabetics.

Eyelid lesions are common, and can be due to many different causes. In the case of a bothersome or concerning lesion, an excisional biopsy of the lesion can be done in the office. Excised lesions are always sent to pathology for a definitive diagnosis.

Glaucoma is a disease of the optic nerve that typically causes damage to peripheral vision, and gradually marches toward the center of vision. The damage caused by glaucoma is irreversible. End stage glaucoma can leave patients with tunnel vision, or total vision loss. Because glaucoma affects peripheral vision first, many patients do not realize there has been damage to their vision until the vision loss is severe. Glaucoma screening tests, such as a visual field test and an optic nerve OCT, can identify early glaucoma damage so that treatment can be started to prevent vision loss. Glaucoma treatment consists of eye drops, lasers and surgery in severe cases.

The drainage structures of the eyes, or angles, must be open in order to effectively drain fluid from within the eye. In some patients, the angles are naturally narrow and can predispose the patient to developing increased eye pressure, sometimes acutely. Signs of increased eye pressure due to narrow angles include eye pain, nausea, blurred vision and eye redness. In order to prevent increased pressure due to narrow angles, a laser can be done in the office in which a microscopic hole is made in the iris. This hole offers an “escape valve” through which fluid can exit the eye if the angle becomes too narrow.

The standard intraocular lens used in cataract surgery is a monofocal lens. A mono-focal lens allows for best possible vision in the distance without glasses, but patients will need glasses for intermediate and near vision. Some patients who have astigmatism may also need glasses for distance since the standard mono-focal lens cannot correct for astigmatism. In patients who have astigmatism and would like the best possible distance vision without glasses, there is an implant option called a toric lens. A toric lens helps to correct astigmatism and offers a patient the best chance of being spectacle-independent for distance vision.

The standard intraocular lens used in cataract surgery is a monofocal lens. A monofocal lens allows for best possible vision in the distance without glasses, but patients will need glasses for intermediate and near vision. New technology has produced an implant that allows the patient to see well at near and distance, reducing or eliminating a patient’s need for glasses at any distance.Called multifocal intraocular lenses, these implants offer a patient the best chance of being free of glasses after cataract surgery.

A pediatric eye exam is often different from an adult exam in that children require different exam techniques and often have different eye conditions that need to be evaluated. Conditions like failed vision screenings, amblyopia, strabismus (misalignment of the eyes) and drooping eyelids are common in the pediatric population. A pediatric eye exam typically consists of evaluation of the patient’s vision, evaluation of eye movement and alignment, an exam of the patient’s ocular structures and determination of any refractive error. Although many children are too young to participate in a refraction, a technique called retinoscopy can be used to determine if a young child needs glasses.

A pterygium is a growth of the conjunctiva in response to chronic sun and wind exposure. When a pterygium causes chronic irritation or vision changes,
surgical excision can be a definitive treatment. Pterygium surgery is a same-day outpatient procedure done at an outpatient surgical facility. A graft is often put in place of the excised tissue to facilitate healing and prevent recurrence.

A refraction is the process of determining what strength of glasses or contact lenses a patient requires for clear vision. A refraction is usually done with the feedback of the patient, although there are methods of determining a patient’s refraction that don’t require the patient’s feedback.

After cataract surgery, the thin membrane that holds the lens implant can sometimes form scar tissue, called a posterior capsule opacification. If the scar tissue progresses enough, it can cause vision changes similar to those caused by a cataract. A laser can be done in the office in which laser is used to break up the scar film and clear the visual axis. Patients typically notice a rapid improvement in their vision after this procedure.