In one of our previous blogs, we discussed primary open angle glaucoma and gave a general overview of the disease, the pathology behind the disease, and some of the various treatments available. One of the available treatment options for glaucoma is an in-office laser procedure called Selective Laser Trabeculoplasty (SLT) which is offered by all of the surgeons at Heimer, Fiore, Turco Eye Care and Surgery. SLT is a non-destructive laser procedure that is targeted at the trabecular meshwork—the area of the eye that is responsible for the majority of the drainage of fluid that is produced inside the eye. Resistance of fluid drainage at this area is thought to cause a pressure increase inside the eye leading to optic nerve damage and glaucoma.

SLT is presumed to work by increasing outflow through the trabecular meshwork and thereby lowering the pressure inside the eye. The procedure takes less than 5 minutes and is relatively painless, only requiring an anesthetic eye drop prior to the procedure. In some cases, your physician may have you use a steroid or anti-inflammatory eye drops for up to one week following the procedure. If successful, the procedure may help to lower your eye pressure without the need for additional eye drops or, in patients who have never been on therapy, it may eliminate the need for eye drops for a period of time.

SLT does not provide permanent intraocular pressure lowering but has the potential to last for several years, and since the laser is not destructive it can be repeated multiple times. Unfortunately, just like not everyone responds to certain eye drops for pressure lowering, not everyone responds to SLT. However, about 70-80% of patients achieve the goal of lowering eye pressure by 15-20% from baseline.

Recent studies, including the LiGHT trial, have confirmed that SLT is a very safe and effective means of achieving eye pressure lowering. In fact, the LiGHT trial found that SLT done as a first-line treatment can actually slow progression of visual field loss as compared to eye drops alone. If you have any questions about SLT or glaucoma, please feel free to contact Heimer, Fiore, Turco Eye Care and Surgery at 814-234-1002.

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Eyelids are wonderful creations to protect our eyes. They help to keep out intruders. They smooth moisture over the surface of the eyes like windshield wipers. And they provide coverage for our eye surface during some of our favorite hours–sleep!

When your eyelids are working well, it is likely you don’t give them a second thought. However, it is quite normal that at some point in your life you may notice a bump on your eyelid. Knowing some common causes may help you determine your next step if you notice a new bump.

One frequent cause of a bump on the eyelid is a stye, or hordeolum. This type of bump is an infection within an oil gland of the eyelid. The oil glands of your eyelids allow for moisture to be smoothed over the surface of your eyes when you blink. However, if bacteria finds its way into these moist, warm oil glands, an infection may result. Not only will you notice a bump on your eyelid, but the eyelid may feel sore and appear swollen and red. The first course of action in the presence of this type of bump is to start using warm, wet compresses on the affected eyelid for about 5-10 minutes four times per day. If the discomfort, redness, or swelling seem to be progressing, an evaluation with your eye care provider is recommended. Your eye doctor may recommend an antibiotic to help the infection clear up.

This stye can also lead to a different kind of eyelid bump, a non-infectious chalazion. In some cases, your body will detect the infection in the oil gland and encapsulate the infection in a cyst with firm walls. This cyst formation is your body’s way of fighting the spread of infection. However, most people do not enjoy being stuck with a hard bump in their eyelid. Frequently, continuing the warm compresses as above will gradually lead to the bump decreasing in size and disappearing. When the bump does not resolve with continued compresses, it is possible that the bump can be removed in the office of your eye care provider.

A third type of bump that is common to eyelids are skin growths and cysts. Skin growths are usually not red, swollen or painful. Usually these bumps develop slowly over a span of months. In many cases, the skin growths are benign. However, the area around your eyes is a common place for the development of skin cancers. If you notice a new bump developing on your eyelid or around your eye area that is an unusual color or seems to be changing in color or shape, make an appointment with your eye doctor.

Following this introduction to eyelid bumps, if you develop any new eyelid changes, you will be armed with some ideas on what a good next step is for your eyelid health. And if you have any additional questions or concerns, do not hesitate to reach out to your eye care provider for more helpful information.

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One in 20 Americans have vision too poor to read a newspaper with ease, watch television, read a product label while shopping, even with eyeglasses.  Low vision is a term that is used to describe a significant vision loss that cannot be corrected fully with eyeglasses, contact lenses, eye medication and/or eye surgery.

Some people are born with low vision, but it can also be caused by health conditions that affect the eyes or an injury to the brain or eyes.  A few of those conditions are as follows: albinism, macular degeneration, diabetic retinopathy, glaucoma, and other conditions such as a traumatic brain injury or stroke.

Help is available for most patients that possess low vision.  If there is enough remaining vision to see a newspaper headline (about an inch high) held at any distance, there is a good probability that vision may be improved by special magnifiers, lenses, technology, or vision enhancement devices.  The amount of benefit gained will depend on the amount of vision remaining, and one’s motivation along with appropriate goals and objectives.  Special devices and training techniques are utilized to enable more efficient use of the remaining vision.  Examples of activities include:

• Reading – using handheld magnifiers, high powered lens systems or electronic magnification devices can help with reading newspapers, the Bible, novels, bills, mail, recipes, or items on your phone.
• Activities performed at arm’s length such as sewing, reading music, or playing cards may require a specialized telescope or loupe magnifier.
• Viewing recreational activities such as sport events, movies, concerts and television may be able to be helped with telescopic or bioptic devices.

Through low vision rehab services, vision is improved but not restored.  With proper training, low vision rehabilitation devices enable a person to perform many visual tasks and activities with greater ease.

Low vision rehabilitation is not a substitute for any ongoing medical treatment, nor will it reverse the process of vision loss or restore sight.  However, in many cases, it can help improve and enhance as much of a person’s remaining vision as possible and assist in their independence and safety.  Please contact our office if you or a family member or friend might be in need of such services.

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It’s no surprise that more than one in ten people wear contact lenses considering they are a safe, convenient, and comfortable alternative to clearer vision without the fogging of lenses, the bulk of a frame, or the discomfort of a nose pad.  But they’re not entirely risk free!  Proper handling and care of the lenses is essential for the longevity of the contact lens, as well as a proper fit for the health of your eye and vision.

Contact lenses are considered medical devices, which means they need to be properly fit by a licensed eye care provider to ensure they have proper movement and coverage which will reduce your risk of contact lens related complications.  The eye care professional will also determine the proper power of the contact lens so you are seeing well.  In the state of Pennsylvania, a contact lens prescription is valid for one year from the date it is given.  A comprehensive eye exam is needed to renew the prescription each year, to prevent contact lens related ocular complications.

On rare occasions, contact lenses can cause infection in the eyes, or corneal ulcers.  In addition to a proper fit, some other ways we can be sure we’re protecting our eyes while wearing contacts would be to follow some simple contact lens hygiene rules:

-Always wash your hands with soap and water, not hand sanitizer, before handling the lenses.

– Don’t “over wear” your contact lenses; make sure you’re taking them out every night and replacing them according to their wear schedule.

– Never soak your lenses in tap water or rinse with saliva, only clean your lenses with fresh contact lens solution.

– Replace your contact lens case at least every three months

– Remove your lenses immediately and contact your eye care provider if your eye becomes red, irritated, painful, or your vision becomes blurred.

Not everyone is a candidate for contact lens wear, but there are many options available.  If contact lenses are something you’re interested in trying, contact your eye care provider for a contact lens fit.

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If you are a parent or a grandparent of a young child, you may wonder if it’s time to set up their first eye examination.  According to the American Optometric Association and the American Public Health Association, your child should have their first eye examination between 6 and 12 months of age and again at 3 and 5 years of age (unless a problem has been identified sooner).  Eye exams for children are extremely important.  Even if your child has undergone a vision “screening” by the school nurse or the pediatrician/family doctor, a comprehensive eye examination is important.  One in four elementary school age children have an undetected vision problem and good eyesight is crucial for learning.  In fact, 80%-90% of what a child learns during the first 12 years of life come through the visual system.

If your child is diagnosed with a problem at their eye exam, most likely it will be nearsightedness, farsightedness, astigmatism or a combination.  However, there are some other less common conditions that tend to show up in an infant/toddler or preschooler such as:

• Amblyopia (also known as “lazy eye”) in which normal vision can’t be achieved – typically in one or both eyes.
• Strabismus (also known as “crossed eyes” or an eye turn) in which the eyes do not maintain proper alignment.
• Convergence insufficiency in which the eyes do not work together during reading tasks or up-close work

The earlier that a vision problem can be detected, the better success we have to rehabilitate and treat that condition.  Your child’s first trip to the eye doctor is an important step in maintaining your child’s health and ensuring his or hear ability to learn and develop.

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VUITY 1.25% is a new prescription eye drop formulated to improve reading vision in adults. Most adults notice a decrease in reading vision beginning in their 40s. This is due to the onset of presbyopia. Presbyopia is caused by a reduction in your eyes’ ability to “zoom in” or focus at near.

One drop of VUITY in the morning in each eye works to constrict your pupil size. When the pupil is smaller with VUITY, many adults note a two to three line improvement in their reading vision abilities on the vision chart.

Studies have shown the eyedrop to be most effective between the ages of 40 to 55. The most common side effects are headache and eye redness. Due to the constriction of pupil size, caution when driving at night or performing hazardous activities in poor light is advised. Some patients also reported temporary problems when changing focus between near and distance objects.

Additionally, rare cases of retinal detachment have been reported with other similar medicines. Immediate medical care would be advised with sudden onset of vision loss, new flashing lights, or new floating spots or shadows in your vision. If you are a contact lens wearer, you should remove your lenses prior to the instillation of VUITY and wait 10 minutes after dosing before reinserting your contact lenses.

A month’s supply of VUITY costs around $80. For presbyopic adults looking to reduce their dependence on reading glasses, VUITY has been a welcome new treatment option. If you are interested in learning more about this promising new eyedrop, contact your eye care provider for an appointment to find out if this medication is right for you.

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On a recent brisk winter day, you may have bundled up into your coat for the cold, windy walk to your mailbox. As the wind chilled your cheeks and ears, you also may have noticed that tears were running out of your eyes. When tearing occurs in the absence of crying, your eyes are “watering.”

Our eye surface does require moisture to remain comfortable and to enable clear vision. In some cases, if our bodies sense a lack of moisture on the eye surface, the eyes will water as a protective response.  One cause of this lack of moisture can be environmental conditions, such as wind or a low humidity environment.  Another cause may be dry eye syndrome, when your eye surface becomes dry from poor quality or not enough tears and your eyes water to compensate for this dryness. Medications, radiation therapy, and health conditions can also contribute to eye surface dryness.

Additionally, our eyes can water in response to an irritant. Some people notice watery eyes in the presence of allergies as the eyes work to wash away the allergens from the irritated eye surface. Many people have experienced watery eyes when cutting onions, which is also a protective response of the eyes. Other irritant causes of eye watering can be infections, such as conjunctivitis, or an eye injury.

Another cause of eye watering can be due to a lack of proper drainage of the tears your eyes produce. The tear ducts normally enable healthy tears to flow away from the eye surface and into your nasal passages. However, in the presence of a blocked tear duct, the eye surface may have too much liquid and the tears will often run down your cheeks.

As you can see, there are several reasons for your eyes to water. In some cases, the watering is an excellent protective mechanism for your eyes. And in other cases, watering can be a sign of a condition that may need attention. If your eyes are watering frequently, your eye care provider will be able to help you sort through the causes and help you find a solution.

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Nonexudative age-related macular degeneration, also known as the “dry” type of macular degeneration, is the most common type of macular degeneration.  The hallmark finding of this type of macular degeneration is accumulation of drusen in the central macula as well as changes to the pigment epithelium of the retina, ultimately culminating in atrophy (also called geographic atrophy) and breakdown of the central macula which can reduce central visual acuity.  The most common form of management of this nonexudative form of macular degeneration has been through the use of oral vitamins, known as AREDS vitamins, of which the most recent and most common is the AREDS 2 formula.  Their use has traditionally been to prevent worsening of disease in patients with intermediate to advanced disease, but they have not been shown to reverse damage that has already accumulated.

Patients often ask if there are any other treatments for nonexudative macular degeneration, and even though there isn’t anything other than AREDS 2 vitamins currently, there are several other treatments being researched for use in the general population.  There are two drugs currently in phase 3 trials, pegcetacoplan and avacincaptad pegol, that are designed to work on decreasing the rate of growth of areas of geographic atrophy.  These drugs are delivered inside of the eye through an intravitreal injection.

Another promising potential new drug is one that has been used for many years in drop form for treatment of glaucoma-brimonidine.  They are studying injecting brimonidine on a biodegradable intravitreal implant into eyes to try to slow the rate of growth of geographic atrophy.

Lastly, researchers are working on implanting stems cells, known as induced pluripotent stem cells, into the retina on a scaffold in an effort to stop the photoreceptor cells from dying.  This novel treatment is currently in phase 1 trials but has very promising potential.

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New experiences can sometimes make us feel nervous, but knowing what to expect can help put our minds at ease. When you have an eye examination, the goal of the exam is to assess your vision as well as your eye health. Additionally, an eye exam can help to detect eye and general health problems before you may notice their effects.

Because your eye health is linked to your overall health, your exam will include gathering information about your current medical conditions, your current medications, as well as you and your families’ medical histories. The best way to share this information with your doctor is to complete our patient paperwork. Our office would be glad to send your forms to complete in advance of your appointment.

In addition to bringing a list of your current medications and supplements to your exam, your eye doctor can also learn more about your visual health when you bring your past pair of glasses and/or contact lenses and boxes. Measuring your vision with what you currently use can help your doctor to assess how to maximize the clarity of your eyesight.

Maintaining healthy eyes is essential to maintaining clear vision. Therefore, your doctor will also assess your ocular health at your examination. By completing simple testing of how your eyes respond to light, measuring the pressure inside of your eyes, and observing the eye structures, your doctor can assess your eyes for common eye diseases and conditions. Your doctor may also recommend eye dilation at your appointment.

Eye dilation occurs when eye drops to widen your pupils are instilled into your eyes. This dilation allows your pupil size to increase temporarily so that the doctor can have a more complete view of the inside of your eyes. Eye dilation can make your vision slightly more blurred for a few hours, however, most people find this effect to be mild.

In summary, an eye examination is essential to maintaining visual clarity and detecting eye diseases and even general health problems before you may be aware a problem exists. Regular eye examinations as recommended by your doctor are valuable in maintaining a lifetime of health vision. And if you have vision changes, eye discomfort, or eye conditions you would like to know more about, your eye doctor is here for you.

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Macular degeneration is an umbrella term for diseases that affect the macula—the location in the retina responsible for your central vision.  Age-related macular degeneration (ARMD) is one of the most common types of macular degeneration and affects almost 10% of the world’s population ages 45-85.  Aside from increasing age, other risk factors for ARMD include positive family history, smoking history, high blood pressure, high cholesterol, obesity, and having a diet high in saturated fats.

There are two types of ARMD—non-exudative and exudative.  Non-exudative, which is commonly referred to as the “dry” form of macular degeneration, is the more common form and is seen in about 80% of patients with ARMD.  Exudative, also called the “wet” form, is less common but nonetheless can cause significant central vision loss.

There is unfortunately no cure for ARMD.  The non-exudative form is generally managed by taking oral medications with special ingredients called the AREDS2 formula which includes vitamins C and E, lutein, zeaxanthin, zinc, and copper.  The exudative form is treated in many cases with injections of medications into the eye called anti-VEGF agents.  These injections help to reduce leakage of blood vessels which can lead to fluid accumulation within and underneath the retina.  Although the central vision is affected in both forms of the disease, patients maintain their peripheral vision.  In many cases, patients learn to adapt to their new level of vision, sometimes with the help of low-vision aides, to maintain the ability to perform their daily visual functions.

It is important to have regular eye exams as you age, especially if you have a family history of significant eye disease.  If you have any questions regarding your eyes or vision, please call our office for a consultation.

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