Ophthalmology

Over fifty percent of people over the age of 60, and quite a few younger than that, suffer from cataracts. Currently there is no medical treatment to reverse or prevent the development of cataracts. Once they form, the only way to see clearly again is to have them removed from within the eye.

In your parents’ or grandparents’ day, cataract surgery was considered risky, required a lengthy hospital stay and was usually postponed for as long as possible. Today, cataract surgery is performed on an outpatient basis and takes only a few minutes. It is now one of the most common and successful medical procedures performed. In fact, many cataract surgery patients experience vision that is actually better than what they had before they developed cataracts.

You will arrive at the surgery center in Pensacola, Florida two hours prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery. The area around your eyes will be cleaned and a sterile drape may be applied around your eye.

Eye drops or a local anesthetic will be used to numb your eyes. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.

Your eye will be completely numbed before the procedure.

A very small incision will be made and a tiny ultrasonic probe will be used to break up the cataract into microscopic particles using high-energy sound waves. This is called phacoemulsification.

The cataract particles will be gently suctioned away. Then, a folded intra-ocular lens (IOL) will be inserted through the micro-incision, then unfolded and locked into permanent position. The small incision is “self-sealing” and usually requires no stitches. It remains tightly closed by the natural outward pressure within the eye. This type of incision heals fast and provides a much more comfortable recuperation.

Vitrectomy is a procedure in which the vitreous humor is removed and replaced with a gas that pushes the retina back onto the wall of the eye. Over time the eye produces fluid that replaces the gas. In both of these procedures either a laser or a cryopexy (a freezing device) is used to “weld” the retina back in place.

If the cornea becomes cloudy as a result of corneal disease, the only way to restore sight is to replace or transplant the cornea. Corneal transplantation (keratoplasty) is the most successful of all tissue transplants. An estimated 20,000 corneal transplants are performed each year in the United States.

Corneal tissue for transplant comes from an eye bank. Due to advances in Eye Banking technology, donor tissue is usually readily available when a patient requires a transplant. The cornea is tested thoroughly to make sure it is safe for transplantation.

What to expect on surgery day:

You will arrive at the Eye Institute at the Medical Center Clinic 30-60 minutes prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery. The area around your eyes will be cleaned and a sterile drape may be applied around your eye. Your eye will be numbed with topical or local anesthetics. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.

Your diseased cornea will be removed with a special round tool called a trephine. Then the donor cornea will be cut to a matching size, placed upon your eye and secured in place with very fine sutures. Your eye will be patched or shielded after surgery.

The surgery itself is painless and usually done on an outpatient basis. The operating time is approximately 60-90 minutes, followed by a short recovery time. You will be allowed to go home soon afterward. You should relax for the rest of the day. You may experience some discomfort for a few days. Eye drops and pain medication can be used to minimize this discomfort.

Everyone heals differently, but most patients resume activities within a few days. Strenuous activity such as lifting, bending or straining should be avoided for several weeks. To protect your eyes from inadvertent trauma, you will be advised to wear shields, glasses, or sunglasses while your eye heals.

The healing process can take many months. Often, the stitches are not removed until six to nine months after surgery. During that time, medicated eye drops will be used to make sure the transplant heals properly.

Realistic expectations:

Return of best vision after corneal transplant surgery may be recognized in three or four months for some, while it may take up to a year after the operation for others. As in any kind of transplant, rejection of the donated tissue can occur. The major signs of rejection are redness of the eye or worsening of vision. Rejection of a donor cornea is rare, but it is very important to contact your eye doctor immediately if the signs of rejection occur.

The success rate for corneal transplants depends on the cause of the clouding. For example, corneal transplants for degeneration following cataract surgery, and those for keratoconus both have high success rates, while corneal transplants for chemical burns have lower success rates.

If you decide that a corneal transplant is an option for you, you will be given additional information that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

If you would like more information about this procedure you can make an appointment or contact the office for additional information.

To control glaucoma, your doctor will use one of three basic types of treatment: medicines, laser surgery, or filtration surgery. The goal of treatment is to lower the pressure in the eye.

Medicines come in pill and eye drop form. They work by either slowing the production of fluid within the eye or by improving the flow through the drainage meshwork. To be effective, most glaucoma medications must be taken between one to four times every day, without fail. Some of these medications have some undesirable side effects, so your Pensacola eye doctor will work with you to find a medication that controls your pressure with the least amount of side effects. Medicines should never be stopped without consulting your doctor, and you should notify all of your other doctors about the medications you are taking.

Argon Laser Trabeculoplasty and Selective Laser Trabeculoplasty surgery treat the drainage canal. Requiring only numbing eye drops, the laser beam is applied to the trabecular meshwork resulting in an improved rate of drainage. When laser surgery is successful, it may reduce the need for daily medications.

Endoscopic CycloPhotocoagulation (ECP) is another type of laser procedure. Instead of treating the drainage canal, it treats the ciliary body. Treating the ciliary body reduces the amount of fluid production thereby reducing the intra ocular pressure. ECP is most often performed along with cataract surgery but can be done on an outpatient basis when in the best interest of the patient. The majority of patients having ECP reduce or eliminate their need to take glaucoma medications.

Filtration surgery is performed when medicines and/or laser surgery are unsuccessful in controlling eye pressure. During this microscopic procedure, a new drainage channel is created to allow fluid to drain from the eye.

Through modern techniques and advances in an eyelid rejuvenation procedure called blepharoplasty, your doctor can help restore a more youthful, alert and healthy look to your droopy eyes. Blepharoplasty has become one of the most popular cosmetic procedures for both men and women because of its high level of patient satisfaction. Blepharoplasty can be performed on both the upper and lower eyelids.

Blepharoplasty is for those who have eyelids encroaching on their field of vision
want to reduce loose skin over their eyes or bags under their eyes

Before surgery:

Your doctor will evaluate the condition and health of your eyes. Specifics regarding your vision, tear production, use of contact lenses, use of medications and personal expectations will be discussed. This information, along with other factors such as age, skin type and ethnic background will allow both you and your surgeon to come to a mutual decision. A plan will be discussed regarding the surgical technique, amount of surgery and type of anesthesia to be used.

What to expect on procedure day:

You will arrive 30-60 minutes prior to your procedure. Once you have been checked-in and settled comfortably, you will be prepared for surgery. Blepharoplasty is generally performed using a local anesthetic. You may be given a mild sedative to help you relax.

If you are having surgery performed on your upper eyelids, your surgeon will remove the excess skin, muscle and fatty tissue that have accumulated in the inside corner of your eye, next to your nose. The incisions will be made along the natural folds in your skin so that as the incisions heal, they become difficult, if not impossible to see.

If your surgery is on your lower eyelids, your surgeon will make the incision inside or behind the eyelid (providing there is not too much excess skin). This technique is called a transconjunctival blepharoplasty, which allows the removal of fatty deposits while avoiding the need for an external incision. If you have excessive skin or muscle folds below the eye, an incision may also be made just below the base of the eyelashes. As this incision heals, the fine scar should become barely visible.

After the procedure you will need to have someone drive you home. You may experience some bruising and swelling for a week to a month after the surgery, longer in some cases. Cold compresses and head elevation will help reduce these effects. Your doctor may also recommend eye ointments and/or eye drops to keep the eye moist and clean.

Postoperative discomfort is usually relatively mild, but your eyes may feel sticky, dry and itchy for a week or so after the procedure. You will need to take special care in cleaning around your eyes for the first week or two.

Stitches are usually removed within five to ten days after surgery. Self-absorbing stitches will dissolve on their own. Make-up or sunglasses may be used to camouflage temporary bruising after the stitches are removed.

Expectations:

The decision to have blepharoplasty is an important one that only you can make. The vast majority of our patients are extremely happy with their appearance after blepharoplasty, however, we cannot guarantee you will have the results you desire. Although the positive effects on your appearance from having blepharoplasty are immediate, your results will not be considered final for up to a year as the healing process continues.

Serious complications with blepharoplasty are extremely rare, but like any surgical procedure it does have some risks. If you decide that blepharoplasty is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

Blepharoplasty is generally considered a cosmetic procedure and most insurance companies will not pay for the procedure. However, if your eyelids are encroaching upon your field of vision, the procedure may be covered as “medically necessary” surgery. We would be happy to contact your insurance carrier to determine if they cover the procedure.

Alternatives to Blepharoplasty

To learn about other cosmetic procedures, please visit the cosmetic procedures section of our Web Site. If you would like more information about this exciting procedure, you may want to make an appointment or request additional information from our practice.

One of the most popular ways to correct vision is with a procedure called LASIK (laser in-situ keratomileusis), which uses a laser to change the curvature of the cornea (outer window of the eye). LASIK has quickly become the procedure of choice for most patients because they recover quickly and have fewer side effects and complications than with other methods of vision correction. In fact, most LASIK patients notice a significant improvement in their vision soon after surgery. LASIK removes tissue within the cornea to treat low to high levels of nearsightedness, farsightedness and astigmatism.

To treat nearsightedness, the steep cornea is made flatter by removing tissue from the center of the cornea. This moves the point of focus from in front of the retina to directly on the retina.

To treat farsightedness, the flat cornea is made steeper by removing tissue outside of the central optical zone of the cornea. This moves the point of focus from behind the retina to directly on the retina.

To treat astigmatism, the cornea is made more spherical — like a basketball instead of a football. This eliminates multiple focusing points within the eye and creates one point of focus on the retina. Astigmatism can be treated at the same time as nearsightedness and farsightedness.

You will arrive at the laser center in Pensacola Florida about an hour prior to your procedure. Once you have been checked in you may be offered a sedative to help you relax. You will then be prepared for surgery. The area around your eyes will be cleaned and a sterile drape may be applied around your eye. Anesthetic eye drops will be used to numb your eyes; no injections or needles will be used.

Next, an instrument called a microkeratome will create a hinged flap of thin corneal tissue, and your doctor will gently fold the flap out of the way. During this process, you may feel a little pressure, but no pain. You will then be asked to look directly at a target light while the laser reshapes your cornea. The Excimer laser will be programmed with the information gathered in your pre-operative exam. The laser treatment will be completed in less than a minute or two, depending on the amount of correction needed. To finish the procedure, the protective layer will be folded back into place where it will bond without the need for stitches. The entire process takes 5-10 minutes per eye.

Following your procedure, your eye(s) will be examined with a slit lamp microscope. Then you will be given additional eye drops, and your eyes may be shielded for protection. Your vision will probably be a little blurry at first, so someone will need to drive you home. You should relax for the rest of the day. You may experience some discomfort for 12 to 24 hours, but this is usually alleviated with an over-the-counter pain reliever. Some people experience sensitivity to light, and watering or swelling of their eyes for a few days following their procedure.

You will be asked to come back the next day for another examination of your eye(s). Most people can actually see well enough to drive the next day but it’s best not to drive until you have been examined. You should be able to resume your normal activities the day after surgery.

Vision can fluctuate for up to six months, but most people can see well enough to pass a driver’s license vision exam following their procedure.

Realistic expectations:

The vast majority of our patients can do most activities without dependence on corrective lenses.

The decision to have LASIK is an important one that only you can make. The goal of any refractive surgical procedure is to reduce your dependence on corrective lenses. However, we cannot guarantee you will have the results you desire. The vast majority of our patients are extremely happy with their vision after LASIK and can do most activities without dependence on corrective lenses.

Serious complications with LASIK are extremely rare. LASIK is a safe, effective and permanent procedure, but like any surgical procedure, it does have some risks. Many of the risks and complications associated with this procedure can be reduced or eliminated through careful patient selection and thorough pre-operative testing using the latest diagnostic technology.

After LASIK, you may experience some visual side effects. These visual side effects are usually mild and diminish over time. But there is a slight chance that some of these side effects won’t go away completely, such as feelings of dryness, glare and halos.

Since everyone heals somewhat differently, some patients may over react to the procedure and some may under react resulting in overcorrections and undercorrections. Once the eye has stablized (3 to 6 months) you and your doctor can discuss whether a re-treatment could help fine tune your vision if you are over or under corrected.

After a thorough eye exam, you and your Pensacola eye doctor will determine if LASIK is an option for you. If you are a good candidate, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

LASIK is not the only surgical procedure designed to correct nearsightedness, farsightedness and astigmatism. To learn about other procedures go to the surgical and laser vision correction procedures section of our Web Site. If you would like to learn more about vision correction procedures from sources other than our practice, we encourage you to link to a number of Web sites we feel provide factual and up-to-date information. You may also choose to make an appointment for a free LASIK screening or request additional information to learn more about this exciting procedure.