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Glaucoma is the progressive damage to the optic nerve due to high intraocular pressure (pressure in the eye).
The intraocular pressure becomes elevated when the aqueous humor (natural fluid in the eye) is unable to drain out of the eye in the normal manner. Regardless of the mechanism of raised intraocular pressure, the goal of treatment remains the same: the reduction of intraocular pressure.
In those with open angles, there is no physical obstruction at the anterior chamber drainage angle.
In trabecular meshwork dysfunction, the cells just do not work as well as they normally do.
Trabecular meshwork obstruction occurs when there is accumulation of material in the trabecular meshwork, causing it to become clogged up. The image above demonstrates the difference between open angle (left) and angle closure (right). Pupil block develops when aqueous is unable to pass from the posterior chamber to the anterior chamber at the level of the pupil.
Plateau iris occurs when the ciliary body is enlarged or rotated forward; this presses and pushes the peripheral iris forward. Laser peripheral iridotomy is the creation of a 'hole' in the iris (white arrow) which allows aqueous to flow from the posterior chamber to the anterior chamber. Acute angle closure glaucoma or acute primary angle closure occurs when the anterior chamber drainage angles become completely occluded and aqueous fluid is completely unable to drain out of the eye. The tell-tale signs of acute angle closure are a red eye (red arrow), mid-dilated pupil that does not react to light (white arrow) and a cloudy cornea. The aims of treatment are to lower the eye pressure rapidly (with eye drops, tablets and possibly an injection into your vein) and to re-open the drainage angle (with indentation, laser iridotomy and possibly laser iridoplasty). To confirm whether your anterior chamber drainage angles are open or closed, your ophthalmologist will perform a special examination called gonioscopy or a scan called anterior segment optical coherence tomography (AS-OCT).
In gonioscopy, a special contact lens is placed on the front surface of your eye after your eye has been numbed with anesthetic eye drops. Anterior segment optical coherence tomography (AS-OCT) is a special scan that takes cross-sectional images of the front parts of the eye, including the anterior chamber drainage angle. New treatment is now available for patients with wet age related macular degeneration (ARMD). Cataract surgery was revolutionized with the invention of intraocular lens implants (IOL’s) a few decades ago.
An IOL was introduced several years ago to address both the distance and near vision requirements of patients undergoing cataract surgery.
Our doctors have chosen to use the Restor lens over the others because of its performance and patient satisfaction. At South Coast Eye Care Centers we take great pride in offering state of the art ophthalmic treatments, including the latest Laser Vision Correction procedures. During our complimentary screening examinations our patient’s eyes are carefully examined in order to determine which of these three procedures would be best. We use only the most modern technologies including broad beam and flying spot lasers, tracking lasers, wave front analysis and treatment, and All Laser LASIK. Laser vision correction has continued to be one of the fastest growing, technologically progressive subspecialties in medicine.
Glasses and soft contact lenses correct the most significant optical deviations of the eye: far-sightedness, near-sightedness, and astigmatism.
In the hands of an experienced surgeon, traditional LASIK carries very small risk and remains the standard of care. Dry Eye Syndrome, also referred to as keratoconjunctivitis sicca, affects more than 6% of the population over 40 years of age and 15 % of those over 65.
The aqueous layer, which accounts for most of the tear film volume and is produced by the main lacrimal (tear) gland and the accessory lacrimal glands.
The lipid layer, which is the most superficial oily layer and is produced by the Meibomian glands. Dry eye syndrome may result from post-menopausal hormonal changes, certain medications, autoimmune diseases, or simply age. An important cause of reduced stimulation of the lacrimal gland is decreased corneal sensation. Recently, studies have shown that dry eye syndrome results in a change in the complex chemical makeup of the tear film.
The second line of therapy is punctual occlusion, which involves the placement of a collagen or silicone plug within the puncta of the lower lids. Mild topical steroids are helpful in reducing the symptoms and pathological findings of dry eye syndrome. Recently, cyclosporine-A (RestasisR), has been FDA approved as an anti-inflammatory treatment for dry eye syndrome. Although anti-inflammatory treatments have an important role in the treatment of dry eye syndrome, it is unclear exactly when this course of action should be utilized. Our eyes, eyelids, and the surrounding area are among the first things we notice about each other. Non-biodegradable fillers consisting of minuscule plastic beads have been injected into wrinkles and depressions in the face, resulting in permanent contour changes. Restylane has many advantages: It consists of a material normally found in our bodies so there is no risk of allergic reaction or disease transmission. Age Related Macular Degeneration (ARMD or AMD) is the leading cause of legal blindness in our nation in people over the age of 65. The macula has one of the highest metabolic rates of any tissue in the body and therefore has a high demand for oxygen, nutrients, and the removal of waste products. At the present time the only approved treatment for dry (atrophic) ARMD is a specific combination of vitamins and minerals, shown in the Age Related Eye Disease Study (AREDS) to slow the progression of the disease in certain very specific types of dry and wet macular degeneration.
Drusen are yellowish deposits beneath the macula, which are often the first sign of macular degeneration.
Several of my patients have sent me forms to fill out so that they might enroll as subjects in a trial of intra-ocular telescopes. Retinal transplants were long thought to be impossible but of course, nothing is impossible.
Investigational therapies for exudative (wet) ARMD include Transpupillary Thermotherapy (TTT), Feeder Vessel Therapy, Rheotherapy, Drug Therapy, Gene Therapy, Radiation Therapy, and innovative surgical procedures. In Transpupillary Thermotherapy, a low power diode laser is used to heat the abnormal blood vessels beneath the macula without actually coagulating them, therefore sparing the overlying rods and cones. Gene Therapy for wet ARMD sounds like science fiction but the first human clinical trial is actually underway in Oregon.
Aggressive and complicated surgical procedures have been designed in recent years to treat exudative (wet) ARMD. In summary, there is aggressive ongoing research into the treatment of ARMD on many fronts. A cataract is the clouding of the natural lens of the eye, which focuses light onto the back of the eye.
New lens implants are being developed that compensate for some of the shortcomings of current vision rehabilitation following cataract surgery. Today diabetic retinopathy is the leading cause of blindness among working age people in the United States. The retina is the inner lining of the back of the eye, analogous to the film in the camera.
Non-Proliferative Diabetic Retinopathy (NPDR), sometimes called Background Diabetic Retinopathy, includes the first signs of eye damage from diabetes. When macular edema occurs, a diagnostic test called a fluorescein angiogram can determine exactly which capillaries are leaking and where.
When the capillary damage becomes severe enough, the retina becomes ischemic, meaning severely deficient in oxygen.
Once neovascularization occurs, it can be halted, and even made to regress, with a laser treatment called pan-retinal photocoagulation or PRP. If the neovascularization is not discovered in time and a vitreous hemorrhage occurs, it usually will clear.
Whenever new blood vessels grow within the eye, they are accompanied by a sheet of supporting tissue. Sometimes, there is an intermediate stage between NPDR and PDR, called pre-proliferative diabetic retinopathy. In summary, diabetic retinopathy can reduce vision in four ways: macular edema, hemorrhage from new blood vessel growth, traction retinal detachment, and loss of the blood supply to the macula. Glaucoma is caused by nerve damage to the optic nerve and in many cases is caused by intraocular pressure (IOP).  Some medical conditions appear to raise the risk of glaucoma including diabetes, migraine headaches, sleep apnea, nearsightedness, and high blood pressure. Research has shown that regular exercise may help to reduce eye pressure as well as having a positive impact on high blood pressure.  In fact, glaucoma patients that exercised regularly for three months reduced their intraocular pressure by 20%. Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes. Glaucoma - increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness in American adults. Moderate Nonproliferative Retinopathy - As the disease progresses, some blood vessels that nourish the retina, are blocked.
Severe Nonproliferative Retinopathy - Many more blood vessels are blocked, depriving several areas of the retina with their blood supply. Proliferative Retinopathy - At this advanced stage, the signals sent by the retina for nourishment trigger the growth of new blood vessels.
Fragile, abnormal vessels can develop and leak into the center of the eye, blurring vision.


Fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead vision occurs.
Your eye care professional can tell if you have macular edema, or any stage of diabetic retinopathy. The Diabetes Control and Complications Trial (DCCT) showed that better control of blood sugar levels slows the onset and progression of retinopathy.
This level of blood sugar control may not be best for everyone, including some elderly patients, children under age 13, or people with heart disease. Other studies have shown that controlling elevated blood pressure and cholesterol can reduce the risk of vision loss. Blurred vision may occure when the macula (part of the retina that provides sharp central vision) swells from leaking fluid. If new blood vessels grow on the surface of the retina, they can bleed into the eye and block vision.
If left untreated, proliferative retinopathy can cause severe vision loss and even blindness. If your eye care professional believes you need treatment for macular edema, he or she may suggest a fluorescein angiogram.
During the first three stages of diabetic retinopathy, no treatment is needed, unless you have macular edema. Scatter laser treatment works better before the fragile, new blood vessels have started to bleed. Both focal and scatter laser treatments are perfomed in your doctor's office or eye clinic. Laser surgery and appropriate follow-up care can reduce the risk of blindness by 90 percent. If you have lost alot of blood in the center of the eye (vitreous gel), you may need a vitrectomy to restore your sight.
Are scatter laser treatment and vitrectomy effecting in treating proliferative retinopathy?
If you have lost some sight from diabetic retinopathy, ask your eye care professional about low vision services and devices that may help you make the most of your remaining vision. The National Eye Institute (NEI) is conducting and supporting research that seeks better ways to detect, treat and prevent vision loss in people with diabetes. For example, researchers are studying drugs that may stop the retina from sending signals to the body to grow new blood vessels (anti-angiogenesis). Disclaimer: The information contained in this website does not substitute for the advice of a qualified eye care professional and is not intended to constitute medical advice. Glaucoma is characterized by damage to the optic nerve, which is usually caused by elevated eye pressure. The doctors at Blackstone Valley Eye Care are experienced and skilled at the early detection and treatment of glaucoma.
When diabetes is not adequately controlled it can cause problems in the eye such as diabetic retinopathy, cataracts and glaucoma. During your eye examination the retina and blood vessels will be thoroughly examined for any abnormalities.
We are continually educating ourselves on the latest treatment options for macular degeneration and work closely with retina specialists to provide you with the best care. Dry Eye is a condition of the eye surface, where either not enough tears are being produced or the tears are of poor quality. Providing family eye care to patients of Woonsocket, North Smithfield, Cumberland, Lincoln, Blackstone, Bellingham, Burriville, Millville and more.
Any obstruction at the anterior chamber drainage angle (angle closure) or dysfunction (and obstruction) of the trabecular meshwork (open angle) means that the rate of aqueous drainage will be less than the rate of production. The resulting build up of fluid in the posterior chamber pushes the peripheral iris against the cornea, thus causing angle closure. Lens-related angle closure is when the increase in lens size pushes the entire iris forward, causing the angle to close. Usually your ophthalmologist will also recommend that you have the laser iridotomy on your other eye because there is a high risk that it will develop the same problem. This contact lens or goniolens allows direct visualization of the anterior chamber drainage angle. The picture on the right shows a diagram of how the anterior chamber drainage angle can be seen directly on gonioscopy with a gonioprism.
It is very useful in confirming whether the drainage angle is open or closed in cases which are not so straightforward. Macleod’s job was a professor in the department of physiology at the University of Toronto. Our highly trained staff and our Board Certified Ophthalmic Surgeons take great pride in our excellent results, which have led to a 100% rate of customer satisfaction among our Laser Vision Correction patients. Measurements including eyeglass power, tear film production, corneal thickness, corneal topography (i.e.
We carefully evaluate which technology and procedure is best for each patient and take great care in ensuring our patients are highly satisfied. Excimer laser computer software has improved dramatically over the past several years with precise eye-tracking systems, smaller spot beams, and smoother ablations. Better night vision – Conventional laser vision correction is known to induce higher order aberrations resulting in night time halos and glare in some patients with more complex prescriptions. Correction of higher order aberrations occurring naturally or induced by conventional laser vision correction – Patients who suffer night vision problems naturally or due to a conventional laser vision treatment may benefit from custom ablation aimed at reducing higher order aberrations. Since higher order aberrations occur naturally and are an integral part of “normal vision,” should they be corrected? Is our current technology accurate enough to both measure and treat higher order aberrations?
Unlike the standard microkeratome blade, the laser may be stopped at any time during the procedure without untoward effects. Although complications due to an imprecise (too thick or too thin) or irregular flap cut with the microkeratome are very rare, the laser offers increased precision in creating the flap. The IntraLASE™ laser requires the eye to be placed under less pressure while creating the flap in comparison to standard microkeratomes. Early studies suggest that fewer higher order aberrations (please refer to the above discussion) are induced by the IntraLASE™ laser compared to microkeratome blades.
Cost – An additional fee is usually charged depending upon the particular surgeon and surgery center utilized. The procedure requires a longer period of time to complete – approximately 30 minutes as compared to 15 minutes. The IntraLASE™ laser further reduces those risks while increasing precision in creating the flap. The symptoms include blurred vision, foreign body sensation (feeling like something is in the eye), burning, irritation, and excessive tearing. This layer provides lubrication of the ocular surface while trapping and eliminating foreign matter from the eye.
A large portion of this layer is produced in response to stimulation of the nerves on the surface of the eye.
They are designed to bypass the function of the diseased retina by capturing incoming light and converting it to electrical impulses.
Cataract is the leading cause of mild visual loss in this country and fortunately is correctable with safe, highly effective surgery. Light rays travel through several structures of the eye before being translated into nervous impulses.
Typically when there is a change in vision associated with cataract, a new pair of eyeglasses will help to restore vision to an acceptable level. These areas of the retina send signals to the body to grow new blood vessels for nourishment. This is proliferative retinopathy and is the fourth and most advanced stage of the disease. That's why everyone with diabetes should get a comprehensive dilated eye exam at least once a year. To protect vision, every pregnant woman with diabetes should have a comprehensive dilated eye exam as soon as possible. Whether or not you have symptoms, early detection and timely treatment can prevent vision loss.
People with proliferative retinopathy can reduce their risk of blindness by 95 percent, with timely treatment and appropriate follow-up care.
The people with diabetes who kept their blood sugar levels as close to normal as possible, also had much less kidney and nerve disease. This allows the eye care professional to see more of the inside of your eyes to check for signs of the disease. To preven progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. If you have macular edema in both eyes and require laser surgery, generally only one eye will be treated at a time, usually several weeks apart. This research is conducted through studies in the laboratory and with patients in clinical trials. Someday, these drugs may help people control their diabetic retinopathy and reduce the need for laser surgery.
Vision loss due to eye disease is usually permanent therefore early detection is critical. Diabetic retinopathy is when blood and fluids leak out of the blood vessels into the retina. If applicable, the root cause of trabecular meshwork dysfunction or obstruction should also be treated.


This physically prevents the aqueous from reaching the trabecular meshwork, and causes intraocular pressure build up.
This laser relieves pupil block and reduces the risk of developing acute angle closure glaucoma (see below). As the eye pressure reduces, your eye will feel more comfortable and your vision slowly recovers. In the rare cases where the acute angle closure recurs despite successful laser iridotomy, laser iridoplasty or even surgery may have to be performed. Your ophthalmologist may need to apply some pressure onto your eye during this examination. In angle closure, the AS-OCT will show the iris pressing against the cornea, thus occluding the drainage angle completely. This layer is then gently rolled back, and the excimer laser is used to re-shape the cornea.
Although there are a few days of discomfort following PRK, some patients choose it over LASIK and LASEK. Wave front technology, one of the latest advances in refractive surgery, has recently received FDA approval. These results were achieved, however, under tightly controlled circumstances and it remains to be seen whether they are reproducible in clinical practice. Limited studies show that custom ablation induces fewer higher order aberrations with fewer patients complaining of postoperative night vision problems.
This application of the technology has not been approved by the FDA but is performed by some surgeons. Recently, the IntraLASE™ Corporation has developed a computer-controlled laser, which creates the flap without the use of a blade. As a result, the likelihood of suffering one of these rare flap-related complications is further reduced. Consequently, this new technique may improve the results achieved with wave front-driven custom ablation. Dry eye syndrome is a complex disease that involves much more than simply the underproduction of tears.
The removal of a cataract is the most commonly performed out-patient surgery, and technological advances have made surgery much less disruptive to patients.
Dilation of the pupil causes the iris to open widely and allows the ophthalmologist to evaluate the cataractous lens more carefully.
When vision cannot be restored to an acceptable level, cataract surgery should be considered. They grow along the retina and along the surface of the clear, vitreous gel that fills the inside of the eye. You need to be examined by your eye care professional at the first sign of blurred vision, before more bleeding occurs.
Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. Even if bleeding has started, scatter laser treatment may still be possible, depending on the amount of bleeding. Your doctor places up to several hundred small laser burns in the areas of retinal leakage surrounding the macula. People with proliferative retinopathy have less than a five percent chance of becoming blind within five years, when they get timely and appropriate treatment. Many community organizations and agencies offer information about low vision counseling, training, and other special services for people with visual impairmants. As the lens continues to cloud, vision will become blurred and colors will appear less vibrant. For instance, if there are blood cells or inflammatory cells in the eye, then treatment with eye drops with anti-inflammation action will help. The first line treatment for angle closure is laser peripheral iridotomy which creates a full-thickness opening in the border of the iris. This is an ophthalmic emergency - if you experience these symptoms, consult your ophthalmologist immediately so that the appropriate treatment can be administered. Don't worry, this is a normal part of the examination although you may feel some discomfort.
AS-OCT is usually performed in the dark, when the pupil is naturally dilated to its fullest and the drainage angle is at its narrowest.
The All LASER LASIK method involves the use of a laser which fires extremely rapidly to create a flap, followed by an excimer laser treatment to re-shape the cornea. This is usually because some patients worry about the integrity of the corneal flap after treatment with the excimer laser.
The screening examination also includes time to discuss the surgery with one of our Laser Vision Correction surgeons. On the other hand, if the microkeratome blade stops in the middle of the procedure, a 2-4 month healing period is required prior to re-treatment.
Also the diameter and thickness of the flap are programmed into the computer before the start of the procedure and preliminary studies show good accuracy. Wave front technology is currently in its infancy but holds tremendous promise for the future of refractive surgery. The cornea is now commonly operated on to obviate the need for eyeglasses using laser vision correction methods like LASIK. Other important examination techniques in the evaluation of cataract include eyeglass measurement and careful examination of the optic nerve and retina. It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. Between 40-45 percent of Americans diagnosed with diabetes have some stage of diabeetic retinopathy. The test allows your eye care professional to identify any leaking blood vessels and recomment treatment. Your doctor places 1,000 to 2,000 laser burns in the areas of the retina, away from the macula, causing the abnormal blood vessels to shrink.
This allows aqueous to flow directly from the posterior chamber to the anterior chamber without going through the pupil, thereby relieving any pupil block and opening the angle.
This same excimer laser is used in all three refractive procedures to change the power of the cornea and thus eliminate the need for eyeglasses and contact lenses. In other cases we may find during our evaluation that PRK is the better method for a given eye.
This concept certainly sounds like a better approach to laser vision correction, but exactly what does it mean, what should we expect from it, and what are the unanswered questions? In the near future this will likely prove a viable option for patients with significant glare and halo symptoms after conventional surgery. No doubt, continued refinement and experience will fine-tune this revolutionary technology to the maximum benefit of future patients. Since the potential for long term side effects exists, the use of these medications should be limited.
Meanwhile, each patient should be evaluated and treated individually with a tailored regimen based on his or her particular needs.
These hemorrhages alone do not cause visual loss but they do indicate that the diabetes may not be under optimal control. This type of cataract in the earliest form sometimes causes an increased ability to see objects up close. If you have diabetic retinopathy, your doctor can recommend treatment to help prevent its progression.
Because a high number of laser burns are necessary, two or more sessions usually are required to complete treatment. Because the vitreous gel is mostly water, you will notice no change between the salt solution and the original vitreous gel. Our practice services patients in Rhode Island ( RI ) and Massachusetts ( MA ) communities.
We are currently using excimer lasers with wavefront technology in order to be able to achieve even better results. Also, what is “all-laser LASIK,” and how does this new technology impact refractive surgery? The pupil is the opening in the center of the iris, and the iris is colored part of the eye.
An airline pilot or a bus driver would have a greater need for sharp vision than a person who doesn't drive a car.
Although you may notice some loss of your peripheral (side) vision, scatter laser treatment can save the rest of your sight.
Because your pupil will remain dilated for a few hours, you should bring a pair of sunglasses.
For instance, a posterior sub-capsular cataract often occurs earlier in life than a nuclear sclerotic cataract and may cause vision loss more rapidly. The natural lens follows, and it is subject to opacification, which leads to cataractous visual loss. The vitreous is often associated with it's own opacities which are commonly known as vitreous floaters. Finally the light arrives at the retina where it is translated into nervous impulses which are sent via the optic nerve to the brain.




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