Baltimore Washington Eye Center, Maryland

Tuesday, August 30, 2011

Keratoconus and Cornea Collagen Crosslinking

Keratoconus is a degenerative condition of the cornea, the clear dome over the colored part of the eye. In patients with keratoconus the cornea thins inferiorly.  As the cornea thins, pressure from the inside of the eye causes it to bulge and take on a steep, irregular cone-like shape.  Early symptoms of keratoconus are rapid changes in prescription often with high amounts of near sightedness and astigmatism, doubling of images, starbursts around lights and being unable to see 20/20 even with the best spectacle prescription.

In the past keratoconus was managed by trying to give the patient the best possible vision. Since the visual symptoms are due to the irregular corneal surface often being fitted with a rigid gas permeable contact lens is often the only way to achieve 20/20 vision. The rigid lens maintains its shape and does not conform to the irregular surface creating an artificially smooth surface that will better focus light.

Keratoconus tends to be progressive. Ten to twenty percent of patients with the disease will develop corneal scarring that impedes vision or will become intolerant of rigid gas permeable lenses. For these people the only way to restore vision is a corneal transplant. Transplants for keratoconus are successful 90 % of the time. However, the recovery is long and arduous and often contact lenses are needed afterward to achieve good vision.

A new procedure undergoing FDA trials is Corneal Collagen Crosslinking with Riboflavin. This is a simple 30 minute procedure where riboflavin is applied to the cornea and activated with an ultraviolet light stimulating crosslinking between the collagen fibers of the cornea. This greatly strengthens the cornea. Researchers believe the procedure may stop the progression of keratoconus permanently.

The advent of such a promising procedure is very exciting. Early diagnosis is critical. If you or someone you know has any of the signs of keratoconus a complete eye exam is warranted.

Guest Blogger: Shari E. Strier, O.D. with the Baltimore Washington Eye Center

Friday, August 26, 2011

Cataract & Prostate Cancer Treatment

Researchers reporting in the Annals of Epidemiology (November 2010) concluded that the risk of developing Cataracts may be higher in patients being treated for prostate cancer with Androgen Deprivation Therapy (ADT). The side effects of ADT such as weight gain, insulin resistance and blood lipid level problems have been linked to Cataract formation. Although further prospective study is necessary to truly understand the findings, researchers from Karmanos Cancer Institute in Detroit used the Surveillance, Epidemiology and End Results Medicare database to analyze cataract formation in prostate cancer patients.

Wednesday, August 24, 2011

Why Do I Have to Wear Sunscreen?

Sunscreen acts as a barrier to the harmful UV rays from the sun that can cause damage to the cells in our body. The most important reason to wear sunscreen is to prevent the development of skin cancers, like melanoma, basal cell carcinoma, squamous cell carcinoma, among others.  This is usually enough to convince people to apply sunscreen at the beach, but what about daily sunscreen use. Patients will often tell me, "I never sit in the sun. I don't need to wear sunscreen daily."  The fact is we are exposed to harmful UV rays from the sun every day, regardless of the weather; just because you are not burning does not mean that sun damage is not occurring.   Even driving in your car, you are subject to the glass-penetrating effects of UV rays.  Daily application of a sunscreen is essential in preventing the breakdown of the healthy skin structure.  UV radiation is one of the major creators of free radicals; free radicals cause a breakdown in the cellular structure of the skin. This can lead to age spots, fine lines and wrinkles, and in the worst case, cancer.

It is important to make sure that whichever sunscreen you choose protects you against both UVA and UVB rays. UVA rays penetrate deep into the skin; they are not filtered by glass and the intensity of these rays does not vary based on time of day or time of year. UVB rays cause damage to the outer layers of the skin and these rays are the primary cause of sunburns. Look for sunscreens that have a blocking agent, like zinc oxide or titanium oxide, as these are the best protectors against all UV rays.  Also choose an SPF of at least 15 or more.

Friday, August 19, 2011

Thyroid Disease Problems in the Eye

Not everyone with thyroid problems develops eye disease, but a high percentage of people with thyroid abnormalities will eventually have eye issues.  It could be something as simple as dry eye, or something much more visually significant, like double vision and proptosis (eye bulging), or it could be vision threatening, like compressive optic neuropathy.  These eye changes can be seen in people with all types of thyroid disorders. Most commonly, they develop in patients who are or were hyperthyroid (overactive thyroid) and most often within the first year of diagnosis. However, eye problems can occur in patients who have an underactive or even normal thyroid function.

What can often be confusing for patients is the fact that the severity and progression of the eye disease is not necessarily correlated with the levels of thyroid hormones.  The thyroid function may be completely controlled and the patient can still see progression of eye disease.

We don't really understand the entire process behind thyroid eye disease, but we do know that it is auto-immune. The immune system reacts to the patient’s thyroid gland cells and causes thyroid hormone abnormalities. This same immune system reaction is also noted in the eye muscles and orbital soft tissue. Inflammatory white blood cells called lymphocytes and fibroblasts cause enlargement of the eye muscles and accumulation of fluid and inflammation in the orbital fat. This process can lead to the development of eye discomfort and proptosis due to the extra pressure on the eye from enlarged eye muscles and orbital fat. Eyelid retraction can be caused by abnormalities to the eyelid muscles and double vision can be caused by asymmetry of the muscles and abnormality of muscle function.

It is important to make sure that the thyroid function is well controlled, because even though thyroid eye disease can progress in the face of normal thyroid function, abnormal thyroid function increases the risk that eye problems will develop.  So it is vital to have a good relationship with your primary care physician and endocrinologist. However, one of the most important things you can do to prevent or improve thyroid eye disease is to stop smoking, if you are a smoker. Studies have shown that patients with thyroid eye disease will exacerbate their problems if they smoke. Furthermore, patients who stop smoking, often see an improvement in their thyroid eye disease.

Tuesday, August 16, 2011

Improve Eye Appearance with Fillers

According a recent publication in the Ophthalmic Plastic and Reconstructive Surgery Journal more and more surgeons are using hyaluronic acid filler injections, like Restylane® and Juvéderm®, to treat the lower eyelid tear troughs. This is proving to be a wonderful alternative to surgery.  The injections are very well tolerated by patients and 85% of patients were happy with their treatment. In fact, 95% of the patients in this study tolerated this procedure. By using these fillers, we can treat the tired, hollow under eye look without the pain and expense of surgery. The side effects of the injections are minimal, mainly bruising and swelling and the occasional blue discoloration and lumps. Compare this with the potential risks of surgery, which include significant bruising and swelling, infection, and scarring which can cause the lower eyelids to be pulled down, thereby preventing complete eyelid closure.
In my experience as an Oculofacial Surgeon, I have had excellent results with these fillers under the eyes and I love the fact that I can adjust the dose based on each patient’s need. Both the patient and I can immediately see results and address any concerns at the time of treatment, rather than wait for surgical swelling to resolve. The product itself is moldable, so if I see any areas that don’t look quite right, I can correct them right then and there. If patients have excess skin, then surgery may be a better option.  And there are other options like laser ablation to help with the quality and texture of the skin; however, in some cases, these can be painful and very expensive.  Nevertheless, for those who want a more youthful appearance without the stress and expense of surgery, fillers like Restylane® and Juvéderm® provide a great alternative.  

The full article can be found in Ophthalmic Plastic and Reconstructive Surgery. 2011; 27(2):69-73. Author: Charles Slonim, M.D., F.A.C.S.
Guest Blogger: D. Chimene Richa, M.D. Oculofacial Surgeon with the Baltimore Washington Eye Center


Thursday, August 11, 2011

Certified Eye Surgery Center by AAAHC

By now you are all very familiar with the Baltimore Washington Eye Center and all the "one-stop" center provides.  But, did you know, it gets even better?  Should you need to have surgery for cataract removal with lens implants, glaucoma surgery, oculoplastic procedures, or a wide variety of other types of ocular surgeries, they can be performed right here at the Baltimore Washington Eye Center.  Since 1986, Baltimore Washington Eye Center has provided excellence in patient care when it comes to eye surgery.  By maintaining ownership of the facility, it can provide a faster and safer, as well as a more pleasant and personal experience than having to go to a hospital.  The choice, however, is always yours as to where you have your surgery done.  

Each patient is asked to complete a satisfaction survey on the day after surgery which may be done anonymously.  Consistently our patients rave about their experience at BW Eye Center. 

Some of the comments are: 
“I wish all surgical experiences were like this one!”
“I loved the caring personnel.”
“Impressed with the efficiency and service!”
“This experience excelled over any other!”
“Everyone is so professional, courteous and efficient!”
“I love my doctor!”

If you have any questions or would like to learn more about our surgical services, give us a call at 800-495-3937.  We would be happy to answer any questions you may have.

Guest Blogger: Katie Guglietta R.N, ASC Manager with the Baltimore Washington Eye Center

Tuesday, August 9, 2011

Contact Lens Compliance is Suspect

New findings being published in Contact Lens & Anterior Eye suggests contact lens wearers do a poor job of complying with appropriate contact lens care. The findings are based upon two online surveys that were sent to just under 1500 randomly selected 12 to 39 years old wearers of silicone hydrogel and hydrogel soft contact lenses. 

Important findings included the fact that almost half of the respondents did not hand wash with soap prior to lens insertion in the morning and removal at night.  Even fewer (about 25%) said that they did not rub lenses with disinfecting solution. Our Refractive Services Director, Dr. Brad Spagnolo, comments that,  “Although many of the disinfecting solutions on the market use words like ‘No rub’, studies still support the continued practice of performing manual cleaning with an index finger to reduce the risk of infection.”

Compliance with lens case care was equally poor or worse with 33 percent responding that they cleaned their cases monthly or less often. Further, most patients reported cleaning the cases with tap water. According to Dr. Shari Strier, Clinical Services Director, this practice can “increase the risk of ocular infections.” And, while lens cases should be replaced about once every 3 months, 48 percent said they replace the storage case once a year or less.

Dr. Spagnolo agrees stating, “Unfortunately, we often find patients wear a set of lens much longer than is recommended, making them more likely to experience ocular discomfort. Perhaps more importantly, this habit may put them at a greater risk for a serious eye infection.”

Dr. Strier summarizes, “We recommend that our contact lens wearers have annual eye exams.  We stress to those patients the guidelines for good lens care and hygiene, including lens cleaning and replacement schedules.

The study was sponsored by VISTAKON, a Division of Johnson & Johnson Vision Care, Inc.

Study Source: Hickson-Curran S, Chalmers RL, Riley C. (In press). Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases. Contact Lens & Anterior Eye (2011) 

Thursday, August 4, 2011

Monovision LASIK for Near Vision

Presbyopia is a condition whereby the crystalline lens inside your eye that is typically soft and flexible begins to lose that flexibility and thus limit your ability to change focus from far to near and near to far. Patients with presbyopia typically report that their “arms are too short” and that near objects and reading material are becoming fuzzy or blurry.

For some patients, LASIK-which is mainly a type of laser eye surgery for correcting distance vision, does have some application in correcting near vision through a technique called monovision LASIK.  Monovision corrects one eye for distance and one eye for near. Thus, the need for glasses with two different focal lengths is resolved by focusing each eye at a different focal length. Monovision LASIK can be effective for some patients with the need for mild near vision correction. Depending on the amount of close work you do at work and for how long each day, monovision LASIK may be a good alternative. One way to get a sense of how you will do with monovision LASIK is to mimic the effect with a temporary pair of contact lenses.

To find out more about monovison LASIK and see if you might be a candidate for this type of near vision correction please feel free to phone Baltimore Washington Eye Center at 410.761.8258 to schedule an appointment for a LASIK consultation.

Tuesday, August 2, 2011

Children's Eye Health Month at Baltimore Washington Eye Center

Baltimore Washington Eye Center wishes to announce that August has been designated as Children’s Eye Health and Safety Month by Prevent Blindness America. Eye and vision problems affect one in twenty preschoolers and one in four school aged children. Parents should be aware that it is possible for their children to have a serious vision problem without even being aware of it. Infants should be screened for common eye problems during their regular pediatric appointments and vision testing should be conducted for all children starting at around three years of age. If there is a family history of eye problems or if an eye problem is apparent, it is important to bring it to the attention of and eye doctor so that they can advise the parents about when and how often their child’s eyes should be examined.

Among the conditions an eye doctor will look for are amblyopia (lazy eye), strabismus (crossed eyes), ptosis (drooping of the upper eyelid), color deficiency (color blindness) and refractive errors (nearsightedness, farsightedness and astigmatism). To have your questions answered about children’s vision problems please feel free to phone Baltimore Washington Eye Center Toll Free at 800.495.3937 to schedule a consultation and examination.