Conditions and Treatments

Cataracts are a normal part of growing old. Cataracts are a cloudiness that develops in the normally clear lens inside the eye and most people develop some cataracts by 60 years of age. This cloudiness progressively worsens until it scatters light entering the eye enough to significantly impact vision. This causes vision to become blurry and colors to appear dimmer or faded. Cataract surgery is the most common procedure performed in the U.S. and is generally very safe and successful with minimal recovery time.

Cataract surgery involves making two small incisions where the white of the eye meets the cornea. The cloudy cataract lens is broken up and removed from the eye using ultrasound energy and is replaced with a new, clear, acrylic lens chosen specifically by the surgeon to correct your vision as fully as possible.

The intraocular lens (IOL) power used by the surgeon can be chosen to “aim” for clear distance vision or clear near vision. Traditional monofocal intraocular lenses still require glasses for patients to see at near if their distance vision is corrected, and vice versa. Modern advancements in IOL technology include multifocal and extended depth of focus IOLs which allow cataract surgery to correct both distance vision and near vision, reducing the need for any glasses after surgery.

Laser cataract surgery has become increasingly popular and offers many benefits for the outcome and safety profile of cataract surgery. Femtosecond laser technology replaces or assists use of a hand-held surgical tool for many of the steps in cataract surgery otherwise done by hand. Use of the laser improves the precision, accuracy and reproducibility of each of these steps, potentially reducing risks and improving visual outcomes of cataract surgery.

By breaking up the cataract into smaller, softer pieces before any incisions are made in the eye, less energy is needed to remove the cataract with laser surgery. This reduces incision distortion and also reduces inflammation. The precise cuts made by the laser also aid in centering the IOL and in treating astigmatism with near-perfect precision.

To reduce astigmatism, small incisions can be placed in the periphery of the cornea. This procedure is called a limbal relaxing incision (LRI) and is often paired with cataract surgery. Surgeons can perform LRIs manually with a blade, but the femtosecond laser makes LRIs with a precision that the human hand cannot achieve. This increases the accuracy of the astigmatism-reducing procedure and maximizes the probability of good vision without glasses after cataract surgery.

Cataract surgery usually takes less than 30 minutes. The laser portion takes just a few minutes at the beginning of the procedure. Patients can immediately resume most normal activities (except for strenuous work or lifting) following cataract surgery. Vision is usually blurry immediately after surgery and may take several days or weeks to fully clear after treatment. There are some risks associated with cataract surgery. These risks may include but are not limited to corneal swelling or abrasions, capsular tear with cataract or lens dislocation, infection, inflammation, eye discomfort, reduced vision.

Extra costs associated with laser cataract surgery and multifocal IOLs are not covered by Medicare or private health insurance.

Many patients suffer from dry and irritated eyes. In a healthy eye, the natural tears that are produced will lubricate and protect the eye. When there is a decrease in the amount of tears or a decline in the tear quality, the eyes become dry and uncomfortable. This can also cause a number of other symptoms including burning, itching, redness, blurry vision, or (counterintuitively) watery eyes.

External factors contributing to dryness include contact lens wear, smoking, overuse of preserved (bottled) eye drops, and computer use.

For people working on their computer all day, dryness can be a serious concern. Studies show that people using a computer have dramatically reduced blink rates. Taking small breaks from computer use and using artificial tear drops can help to keep the eyes lubricated.

An eye exam may reveal identifiable and treatable causes for dry eyes. An exam includes evaluation of the meibomian glands, which produce the oils that prevent tears from evaporating quickly. Warm compresses, omega-3 supplements and artificial tears may be sufficient in mild cases. More severe cases may require antibiotics or steroids.

An eye exam may alternatively identify a decrease in the amount of tears that produced. Supplementing the tear film with artificial tear drops may be beneficial. Depending on how often these artificial tears are needed, a preservative free eyedrop may be best. Punctal plugs are another effective option to retain the tears on the front surface of the eye, preventing them from draining away as quickly. Plugs are easily placed in the office without pain or discomfort and begin working immediately.

Due to the vary complex nature of dry eyes, it is important to have your eyes evaluated by an eye care professional to determine the underlying cause and type of dry eye that you suffer from. There are numerous treatment options and it is important that a doctor work with you to find the best one for you. Dry eyes are often a chronic disorder that will require constant treatment and monitoring.

Blepharitis refers to chronic inflammation of the eyelids and the eyelid oil glands in particular. It is a common disorder of the eye and is often an underlying reason for eye discomfort, redness, and tearing. Blepharitis does not affect vision generally, although a poor tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day. Blepharitis can also lead to the formation of a stye, chalazion, or recurring conjunctivitis (pink eye).

Blepharitis requires long term maintenance. The goal is to continue the minimum amount of therapy needed to keep symptoms under control. In many cases, good eyelid hygiene and a regular cleaning routine can control blepharitis. This includes regular warm compresses and eyelid scrubs to keep the eyelids clear of bacteria and buildup.

In addition to proper lid hygiene, your eye doctor may also recommend additional treatments such as Omega-3 fatty acids (found in fish oil or flaxseed oil). Sometimes prescription antibiotics to help control blepharitis may also be recommended.

Our office also offers BlephEx™, an in-office treatment for blepharitis. It is a procedure that allows us to take an active role in treating blepharitis. This treatment reduces buildup and bacterial debris, the main causes of inflammatory lid disease, and improves the overall health of the eyelid. The treatment is well-tolerated and only takes a few minutes to perform. BlephEx™ can save the patient hundreds of dollars in the costs of prescription drops and artificial tears.

Glaucoma is an eye disease affecting the optic nerve and can cause progressive, permanent vision loss. It is the second leading cause of blindness and is typically painless. People of all ages are at risk of glaucoma, but older age is a risk factor, in addition to smoking, family history, prior eye trauma, prior steroid use, and certain ethnic backgounds. Vision loss typically begins with the peripheral vision and develops gradually. Some patients with glaucoma may not notice any vision loss until significant damage has been done.

Glaucoma is often (but not always) caused by high eye pressure or intraocular pressure (IOP). We measure this at each exam using an eye drop with a yellow dye and anesthetic as well as a probe that gets close to the eye. Some offices use the “air puff” test. Average IOP is between 10-20 (mmHg). Readings of 21 and over are considered elevated and suspicious for glaucoma. These elevated readings may require additional testing or treatment depending on the patient’s risk factors.

The key to glaucoma treatment is early detection. Glaucoma is typically diagnosed after a series of exams in order to monitor the IOP fluctuations, changes to the peripheral and central vision, as well as changes to the optic nerve. Treatment initially consists of eye drops to lower the IOP.

If this fails to sufficiently lower the pressure, surgical and laser procedures can be performed. Unfortunately, there is no cure for glaucoma and any vision loss is permanent. While treatment aims to slow down or stop the loss of additional vision, about 10% of those under proper treatment will continue to progress and lose vision.

Due to the chronic nature of the condition, frequent eye exams are important to monitor the eye pressure, peripheral vision and optic nerve, and must be monitored for life.

Age-related macular degeneration (ARMD or AMD) is a degenerative disease that affects your central vision and is usually detected in patients who are 60 and older. The macula is the central portion of the retina and contains a high concentration of photoreceptors responsible for central vision. There are two types of AMD: Dry and Wet, and both can significantly interfere with a patient’s central vision. Dry AMD is the most common form, has a slower onset, and is characterized by a build-up of deposits in the macula called drusen. A few deposits can be a normal part of the aging process and do not necessarily compromise vision. Wet AMD has a faster onset and will significantly impair vision if not treated right away. This type of AMD is characterized by the growth of abnormal blood vessels which leak blood and fluid into the macular retina. This will typically cause a loss in central vision and patients may describe words on a page as missing or distorted.

Both forms of AMD are treated with eye vitamins that have been shown to prevent further damage to the macula. Studies have shown that these vitamins do not provide any benefit for patients without AMD or who have a very early stage of AMD; therefore most providers do not prescribe these vitamins to patients who have no signs of the disease. Laser treatments and intravitreal injections are other treatment options that have been approved for patients that have wet AMD. The injections work by inhibiting the growth of the abnormal blood vessels in the macula. Even with these treatment options, AMD can be a debilitating disease that can start with minimal symptoms but eventually may lead to blindness. Early detection and treatment are critical to prevent vision loss.

Diabetes is a chronic disease which can affect many organs in the body including the eyes. It is important for all patients with diabetes to have annual eye exams because damage may occur in the eyes even before a patient notices any changes in their vision. If left undetected, it is possible to have permanent vision loss or even blindness due to diabetes. Diabetes causes damage to the blood vessels in the back of your eyes. Diabetic retinopathy is the leading cause of blindness in middle aged-patients in the United States. Chronic uncontrolled blood sugar is the driving factor for diabetic retinopathy but additional risk factors exist. These include, high blood pressure, smoking, high cholesterol, pregnancy, and family history.

Sometimes retinal imaging or scans are helpful in determining the extent of damage that has occurred. If you are diagnosed with diabetic retinopathy there are treatment options that can prevent further vision loss. However, strict management of the diabetes remains the best prevention from severe vision loss.

Keratoconus is a disease of the cornea, the clear tissue at the front of the eye. Keratoconus causes the cornea to become thinner over time and bulge into a cone shape. When this occurs, the vision will become blurry and more difficult to correct with glasses or contacts. Diagnosis is made by measuring the corneal curvature and examination with a complete eye exam. Keratoconus affects one in 2000 people and usually begins to develop in the teenage years or early twenties.

In the early stages, vision can be corrected by glasses or soft contact lenses. As the disease progresses, hard contacts are often required. Rigid gas permeable (RGP) and scleral contacts work by providing a new smooth surface on top of the bulging cornea to provide clearer vision. They are made of a durable plastic that can transmit oxygen and maintain its shape over the eye.

Scleral contact lenses are an option for moderate to advanced stages of keratoconus. These hard contact lenses are larger than the typical hard contact lenses. Because of the larger size, they sit on the white of the eye, the sclera, making them more comfortable to wear. Whereas soft contact lenses need to be replaced on a daily or monthly basis, hard contact lenses are only replaced every 1 to 2 years.

When the corneal thinning is stable and has not progressed, correcting the vision with contacts and yearly exams is all that is recommended. In progressive cases where the cornea continues to change shape, there are several options to treat the condition. Collagen cross-linking is a procedure in which vitamin B2 (riboflavin) is applied to the surface of the eye and UV light is carefully directed to the eye to strengthen the cornea. This can stabilize and even improve the corneal shape, resulting in better vision and the ability to wear contact lenses. In advanced cases with progressive corneal thinning, scarring can develop which causes permanent damage to the cornea. In these cases a corneal transplant may be necessary.

At Washington Pacific Eye Associates we are able to diagnosis keratoconus and we have a contact lens specialist who can fit you with scleral lenses or gas permeable lenses if you need them. This specialized fitting cannot be done at most other eye care facilities.

Botox, or botulinum toxin, is a protein developed for medical and cosmetic use. Injection of botox effectively weakens muscles at the site of injection for approximately 3 months.

Involuntary eyelid twitching typically involves a spasm of the eyelid, which can last for a few seconds to minutes or even throughout the day. This twitch is known as myokymia and is associated with lack of sleep, increase in stress, increased caffeine intake, or any cause of eye irritation. If the twitch is persistent or becomes more severe we call this blepharospasm. This condition can cause more pronounced lid twitching and can even cause the entire eyelid to fully shut without any conscious control. This condition is often treated with botox injections to relax the muscles around the eye.

Botox injections can also help with wrinkles around the eyes and furrows between the brows. Injections relax the underlying muscles, smoothening the skin to result in a more youthful appearance. Injections are generally painless and take only a few minutes but the results will last for several months. It is important to have a skilled physician perform the botox injections to target the correct muscles. Improper injections can cause the eye to not shut completely during blinking which may lead to dry and gritty eyes.

Myopia (nearsightedness) is a common eye condition usually detected at a routine eye exam or at a school screening. Having a myopic prescription means that you have difficulty focusing on objects in the distance but can likely see near objects more clearly. With the use of glasses or contacts, most nearsighted patients are able to achieve clear vision. The degree of myopia a patient has will determine if the patient needs to wear full time or part time correction.

Hyperopia (farsightedness) is another common eye condition that can be detected at a routine eye exam. Having a hyperopic prescription means that you may have more difficulty focusing on near objects but maybe able to see objects in the distance quite clearly. However, hyperopia affects people differently and some hyperopic patients may not notice any vision problems at all when they are young. Mild hyperopia is normal for infants and young children and does not require visual correction. With the use of glasses or contacts, most farsighted patients are able to achieve clear vision. The degree of hyperopia a patient has will determine if the patient needs to wear full-time or part-time correction.

Astigmatism is an eye condition in which one direction of curvature of the cornea is more sharply curved than its opposite direction. Patients can have an astigmatism in addition to being nearsighted or farsighted. Patients with astigmatism may notice more blur or glare around images at both distance and near. With the use of glasses or toric contact lenses, most astigmatic patients are able to achieve clear vision.

Presbyopia is a normal age-related change which occurs for everyone, generally around the age of 45. It is a gradual change which causes an inability of the eye to focus on near objects. Although presbyopia is something that all people will eventually encounter, nearsighted and farsighted patients may notice the start of presbyopia at different times. With the use of glasses or contacts most patients are able to achieve clear vision.

Contact lenses are a great alternative to glasses for patients to achieve clear vision. Most soft contacts are made for daily, two week, or monthly replacement. Daily contacts lenses are used for a single day and discarded afterwards, while extended wear lenses can be worn many times but should always be taken out at nighttime. There are some extended wear contacts that are FDA-approved for continuous or overnight wear, though most eyecare providers discourage this due to increased risk of infection.

Contact lenses can correct common refractive errors such as myopia, hyperopia, astigmatism and can even address the needs of presbyopic patients. Toric contact lenses are worn by patients who have astigmatism. These lenses have two different powers in two different axes to correct the astigmatism. Based on your individual ocular health, visual demands and needs as a patient, your eye doctor can select the correct contact lens for you. It is important to remember that while contacts are relatively safe, they are considered a medical device and proper initial training on insertion and removal of the lenses as well as following a specific cleaning regimen are needed to ensure good ocular health.

For patients with presbyopia, a monovision contact fitting or multifocal contact lenses can be a way to avoid wearing reading glasses. Multifocal contacts are designed with a concentric ring pattern to allow focus for vision both far and near. Until a patient has a contact lens fitting, it is difficult to know if they will be successful in monovision or multifocal contacts. These contact options do require some adjustment time but many presbyopic patients are able to enjoy an active lifestyle with minimal or no dependence on reading glasses.