Ophthalmology and Corrective Eye Surgery Treatments
At our Denver ophthalmology center, our corrective eye surgery specialists focus on treating many refractive errors, eye diseases and eye conditions. These common eye afflictions affect millions of Americans, causing blurry vision, physical discomfort and, in some cases, significant vision loss and even blindness. But in most cases, our expert eye doctors can restore perfectly clear vision to patients who previously suffered from a variety of vision problems.
Corrective Eye Surgery for Refractive Errors
Refractive errors are the result of imperfections in the shape of the cornea (the clear covering tissue of the eye) or other parts of the eye. The most common are myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (misshapen cornea). Refractive errors can be corrected with LASIK corrective eye surgery or PRK performed at our Denver-area laser center.
A person who can see objects up close but has difficulty focusing on objects at a distance suffers from myopia, also known as nearsightedness. Myopia is generally a mild and manageable condition; however, severe myopia can lead to more serious eye problems.
Hyperopia is the condition of being farsighted, meaning a person can not see far-away objects and images clearly and has trouble reading a book or newspaper or doing other activities that require clear up-close vision. Hyperopia results from the eye being too short or a cornea that is too flat, both of which cause images to focus at a point behind the retina, resulting in blurred vision.
Astigmatism is a refractive error caused by an imperfection in the shape of the cornea. Instead of being smooth and evenly shaped, a cornea with astigmatism is irregularly shaped in some areas, preventing the eye from focusing properly. The degree of astigmatism depends on how misshapen the cornea is. Corrective eye surgery treatments for astigmatism are available at our Denver-area ophthalmology practice.
Emmetropia is a state in which the eye is relaxed and remains focused on an object more than 20 feet away. The light rays coming from that distant object are focused on the retina without effort (an emmetropic eye does not need corrective lenses). If the gaze shifts to something closer, focusing cannot be accomplished without effort. In other words, the eye automatically focuses on objects in the distance unless the person makes an effort to focus elsewhere. There is corrective eye surgery to effectively treat emmetropia.
In addition to refractive errors, such as myopia, hyperopia and astigmatism, a person’s vision can be affected by a number of eye diseases. Some eye disease is treatable with corrective eye surgery while others are treated without surgery.
Glaucoma is an eye disease that causes damage to the optic nerve and is a leading cause of blindness. Contrary to popular belief, glaucoma is not limited to the elderly. In fact, the disease can affect children and young adults as well. Glaucoma occurs when the natural fluids of the eye do not drain properly, raising pressure inside the eye. Over time, this elevated pressure can damage the optic nerve, leading to the development of glaucoma. Other causes of glaucoma depend on the specific type of glaucoma a person develops. Because glaucoma can occur at any age and presents such a danger to vision, we strongly recommend having regular eye checkups.
Types of Glaucoma
Open-angle glaucoma, the most common form of the disease, affects approximately three million Americans. The form of glaucoma occurs when fluid drains too slowly from the angle between the iris and the cornea. The built up fluid elevates pressure within the eye, which, if left untreated, can damage the optic nerve damage and lead to blindness. The same fluid buildup can also occur if the eye produces excess fluid. Glaucoma treatment usually begins with the use of oral and/or topical medication. If the person does not respond to the medication, corrective eye laser surgery or incisional surgery may be an option. Open-angle glaucoma can be primary (occurring for no known reason) or secondary (occurring due to previous illness or injury).
Normal-tension glaucoma, also called low-tension glaucoma or normotensive glaucoma, accounts for about 25 to 30 percent of all glaucoma cases in the United States. Unlike other forms of glaucoma, this disease is not associated with elevated intraocular pressure. Patients with this type of glaucoma have normal pressure inside their eye, but have some optic nerve damage.
Glaucoma Treatment Options
While glaucoma cannot be cured with medication or corrective eye surgery alone, several treatments can slow or stop its spread. Treatments for glaucoma generally are intended to reduce intraocular pressure, or pressure within the eye. Medications are usually used first in treating glaucoma.
If medication fails, there are three types of laser corrective eye surgery that can be to treat glaucoma:
- Laser or Incisional Trabeculoplasty—The surgeon uses a laser to improve the eye’s internal drainage system, increasing the flow of fluid to and from the eye and reducing the eye’s internal pressure. Through corrective eye surgery, pressure can be reduced by 60 to 70 percent following trabeculoplasty, which is most commonly used to treat patients with open-angle glaucoma.
- Iridotomy—This procedure is most often used to treat closed-angle glaucoma, which occurs when the angle between the iris and the cornea in the eye is too small. As a result, the iris blocks fluid drainage, increasing inner eye pressure. Iridotomy laser corrective eye surgery creates a small hole in the iris, allowing it to fall back from the fluid channel so fluid can drain.
- Cyclophotocoagulation—This corrective eye surgery is often the next step when other forms of glaucoma surgery have failed. During the procedure, the surgeon uses a laser to burn ciliary tissue, which decreases the production of fluid in the eye. Cyclophotocoagulation, which is performed under local anesthesia, has only recently become available to glaucoma patients. Many patients require more than a single treatment, but cyclophotocoagulation appears to have significant success and relatively low risk.
If laser surgery fails to lower the pressure on the eye, conventional glaucoma surgery, known as trabeculectomy, or filtering surgery, may be used. This outpatient procedure involves the removal of a tiny piece of tissue from the eye at the point where the iris (the colored part of the eye) meets the white part of the eye. Doing so creates a new drainage path that increases the outflow of fluid from the eye. Contact Spivack Vision Center in Centennial, Colorado for more information about corrective eye surgery for glaucoma.
Macular degeneration is a leading cause of vision loss and blindness in Americans over age 65. The disease slowly destroys central vision and is primarily caused by aging; although smoking, hereditary factors, obesity, and inactivity are also thought to be causes.
Age-related macular degeneration, the most common cause of severe vision loss for people over age 60, affects a person’s central vision, making it hard to drive, read, and enjoy other activities. The disease occurs when the center of the retina, called the macula degenerates causing the central vision to deteriorate. Whereas healthy eyes see an entire image, macular degeneration causes dark or blind areas in the central field of vision. Eventually, complete vision loss or blindness can occur.
Types of Macular Degeneration
About 9 out of 10 people with age-related macular degeneration suffer from dry macular degeneration, an early and less severe stage of this disease. Though the cause of dry macular degeneration is not clear, part of the retina becomes diseased, which leads to the destruction of the light-sensing cells in the macula. Aging and thinning of macular tissues can also lead to dry macular degeneration.
Approximately 10 percent of people are affected with an advanced type of age-related macular degeneration known as wet macular degeneration. More advanced and damaging than dry macular degeneration, wet macular degeneration leads to the formation of new blood vessels within the eye that leak fluid and blood under the macula. This fluid leakage damages the macula and leads to vision loss in a short amount of time.
Treating Macular Degeneration
Some forms of dry form of macular degeneration, which affects the vast majority of patients who are diagnosed with the eye disease, is treatable. Incorporating antioxidant and nutritional supplements into your diet has been shown to slow its spread.
When the condition is detected early, wet macular degeneration is most commonly treated with laser eye surgery or photodynamic therapy. These treatments can effectively stop further formation of blood vessels, and have been proven effective at reversing damage that has already occurred.
Contact our Denver-area practice to learn more about macular degeneration.
Diabetic retinopathy is a degenerative eye disease that occurs in people with diabetes, and it can lead to severe vision loss or blindness if left untreated. The primary cause of diabetic retinopathy is diabetes, and anyone with Type I or Type II diabetes can develop this degenerative eye disease. Pregnant women with diabetes are at an even higher risk for diabetic retinopathy and must have their vision checked at an ophthalmology practice every trimester during their pregnancy.
Diabetic Retinopathy Treatment Options
Diabetic retinopathy is best treated by either laser photocoagulation or vitrectomy surgery at our ophthalmology centers. Both are most effective when the disease is detected early, so it is important for diabetics to have regular eye exams.
Laser photocoagulation is a corrective eye surgery intended to seal damaged or abnormal blood vessels and prevent them from leaking. While this treatment does not restore lost vision, it can prevent further deterioration, which is why early diabetic retinopathy diagnosis through routine eye exams is imperative.
Laser photocoagulation can be performed in two ways. In the case of focal macular edema, where the blood vessels are leaking from specific points within the eye, the surgeon will use the laser to seal the blood vessels. In the case of diffuse macular edema, where the leaking is more widespread, the doctor will perform a grid laser photocoagulation treatment over a general area.
During a laser photocoagulation procedure , the patient’s forehead and chin are placed in a slit lamp. A slit lamp is a microscope which uses a line of light, or a slit, to assist your doctor in clearly viewing the portions of the eye which will be operated on. The doctor then places a specially designed contact lens over the cornea, helping focus the laser on the retina. The patient may see flashes of bright light throughout the procedure.
Laser photocoagulation is an outpatient procedure, and patients are able to go home immediately after surgery. However, for about a day after the procedure, vision may be hazy or blurry. Because laser photocoagulation involves tiny burns to seal leaking capillaries, small spots may appear in the field of vision. These small spots generally fade and disappear with time.
While laser photocoagulation can successfully repair leaking blood vessels, new leaks may still occur. Therefore, it is important that diabetic retinopathy patients control their blood sugar and have frequent eye examinations from a qualified eye specialist.
Corneal Disease Treatment
The clear tissue on the outside of the eye is called the cornea. Diseases which affect the functioning of the cornea can cause clouded, distorted vision and eventual blindness. While there are many types of corneal disease, the three major types are keratoconus, Fuchs’ endothelial dystrophy, and bullous keratopathy.
Keratoconus causes weakening and thinning of the central cornea, allowing the cornea to eventually develop a cone-shaped deformity. Keratoconus, which can develop rapidly, gradually, or in spurts, usually occurs in both eyes, but can occur in only one eye.
Fuchs’ endothelial dystrophy is a hereditary abnormality of the endothelium, the inner cell layer of the cornea, which is responsible for pumping fluids out of the cornea, keeping it thin and crystal clear. When the endothelium is not healthy, fluids are not pumped out and the cornea develops swelling, causing it to become cloudy and vision to decrease.
In bullous keratopathy, the cornea becomes permanently swollen after the endothelium has been damaged and is no longer pumping fluids out of the tissue.
Treating Corneal Disease
When a damaged or clouded cornea leads to vision loss, replacing the natural cornea with corneal transplant is the most common treatment option. This corrective eye surgery procedure, commonly known as corneal transplant, can correct vision loss in most patients.
For more information about corneal disease and the treatment options that are available, please contact our Denver practice today.
Besides refractive errors and eye diseases, a person’s vision can also be affected by numerous eye conditions. The expert doctors at Spivack Vision Center are uniquely trained to treat all eye conditions so that patients can enjoy optimal vision and eye health.
The cornea is the clear surface of the eye, and a scratch in the outer layer of the cornea is called a corneal abrasion. Small abrasions usually heal quickly, sometimes within hours, while deeper or bigger scratches can take up to a week to fully heal. Because the cornea has a large number of nerve endings, any scrapes to the cornea are very painful.
When the surface layer of the cornea, called the epithelium, is torn or broken and the underlying tissue, the stroma, is damaged, a corneal ulcer can result. The ulcer is usually caused by microorganisms, which gain access to the stroma through the break in the epithelium.
Corneal ulcers generally heal quickly if they are treated early and aggressively. However, if they are neglected, corneal clouding and even perforation (a hole in the cornea) may develop, resulting in serious loss of vision and possibly loss of the eye. Therefore, a corneal ulcer is a serious vision-threatening condition that requires prompt medical attention.
Flashes and Floaters
Flashes and floaters are a condition in which a patient perceives small, floating spots and bright flashes of light in the field of vision. While they can be alarming, an eye examination by trained ophthalmology expert usually will confirm that they are harmless and do not require any treatment.
Causes of Flashes and Floaters
Flashes and floaters are most often caused by age-related changes in the gel-like material, called vitreous, that fills the back of the eye. At birth, the vitreous is firmly attached to the retina. In very young children, the vitreous is thick, like firm gelatin. The vitreous holds clumps of gel or tiny strands of tissue debris left over from the eye’s early development. These clumps or strands are firmly embedded in the thick, young vitreous and cannot move around much.
As a person gets older, the vitreous gradually thins and becomes more watery. By the time the person is in his or her twenties or thirties, the vitreous may be watery enough to allow some of the clumps and strands to move around inside the eye. This material floating inside the eye can cast shadows on the retina, which appear in the vision as small floating spots.
Sometime after about age 55, many people experience the onset of larger, more bothersome floaters or flashes of light. By this age, the vitreous gel has usually become much more watery and it jiggles around, making flashes and floaters much more common and visible. If you experience flashes that seem to appear all of a sudden, or greatly increase in number, it may mean that there is a problem and an eye doctor should be consulted. To learn more about flashes and floaters, contact one of our doctors.
Conjunctivitis is an inflammation of the conjunctiva, the thin, clear membrane that covers the front of the eye and surface of the inner eyelid. The conjunctiva, which contains many small blood vessels, lubricates and protects the eye while the eye moves in its socket. When the conjunctiva becomes inflamed, this is called conjunctivitis.
Bacterial conjunctivitis is commonly known as “pink eye” because it typically causes reddish swelling of the eyelid and a yellowish discharge from the eye. Sometimes the condition causes itching of the eyelids. Pink eye is caused when eyes become irritated by bacterial or viral infections, allergies, or foreign elements such as dust, chemicals, pollen, or even contact lenses. Bacterial conjunctivitis is very contagious and can be easily transmitted by rubbing the eye and then infecting household items such as towels or handkerchiefs. Therefore it is common for entire families to become infected.
Pink Eye Prevention
Since pink eye passes quickly between infected people, our doctors advise taking certain precautions to avoid the disease and stop its spread. Careful washing of the hands, the use of clean handkerchiefs, and avoiding contagious individuals are all helpful. Children frequently get conjunctivitis because of poor hygiene.
If you or someone in your household has contracted conjunctivitis, follow these steps to prevent the spread of the infection:
- Every time you touch your eyes or face, including when administering medicine in your eye(s), wash your hands thoroughly.
- Wash any clothing touched by infected eyes, including clothes, towels and pillowcases.
- Do not share make-up. If the infection is caused by bacteria or a virus, you must throw away your used make-up and buy new makeup.
- Do not touch the infected eye because you can easily spread the infection to the other eye.
Treating Pink Eye
Pink eye can be treated effectivelywith antibiotic or anti-inflamation drops.
Dry Eye Treatment
For many people, it is confusing to learn that the eye condition commonly called “dry eye” results in red eyes and/or excessive watering. The apparent contradiction makes more sense, though, when they learn that the eye makes two different types of tears.
Lubricating tears, which are produced constantly by the eyes, are made up of mucous, water, oil, nutrient proteins, and antibodies designed to replenish and guard the front surface of the eyes.
Reflex tears, on the other hand, are produced by the body in order to flood the eye when it becomes irritated or injured. Reflex tears are common when dust, smoke or some other substance come into contact with the eye and cause irritation or when the surface of the eye is accidentally scratched. The tears arrive in such large amounts that the eye is flushed of the irritant. These tears can arrive in such a large number that they spill out of the eye and roll down the cheeks of the face, since the eye’s own drainage system is not equipped to handle so many tears.
Dry Eye Causes
Dry eye can be caused by a variety of factors, including:
- Age: As we get older, the glands in the eyelid produce less oil that keeps tears from evaporating from the eye. Decreased oil production allows tears to evaporate too quickly, leaving the eye too dry.
- Diseases including diabetes, Sjogren's and Parkinson's
- Hormonal changes in women, especially after menopause
- Prescription medications: Some high blood pressure medications, antihistamines, diuretics, antidepressants, anti-anxiety pills, sleeping pills and pain medications. Over-the-counter medications, including some cold and allergy products, motion sickness remedies, and sleep aids, can also cause dry eye.
- Hot dry or windy conditions: High altitude, air conditioning, and smoke can also cause dry eye.
- Using a computer
- Watching TV
- Contact lenses
- Eye surgery: Some types of eye surgery, including LASIK, can aggravate dry eye.
- Inflammation: Recent research suggests that dry eye may be caused by inflammation due to an imbalance of "good" fats and "bad" fats.
Dry Eye Treatment Options
Dry eyes are most commonly treated with the use of artificial teardrops that help make up for the lack of natural lubricating tears and often provide immediate relief from irritation and red eyes. Artificial tears can generally be used as often as needed, from a few times per day to every few minutes. They come in liquid form and longer lasting gel forms, and in a long-lasting ointment, which is most often recommended for nighttime use. Many different brands of artificial tears are available over the counter.
There are now FDA approved medications that have been proven to actually stimulate tear production, rather than just tear replacements. For severe cases of dry eye, a treatment call autologous serum tears can be used.
Learn More about Eye Health and Corrective Eye Surgery
Spivack Vision Center, serving Denver and Centennial, Colorado, offers a full range of services and corrective eye surgery procedures. To learn more about our corrective eye surgery services and the procedures we perform, contact our practice today!