Baltimore Washington Eye Center, Maryland

Wednesday, December 28, 2011

In order for everyone to enjoy a fun, safe and injury-free New Year's Eve, the American Academy of Ophthalmology is providing instruction on how to properly open a champagne bottle.

  • Make sure sparkling wine is chilled to at least 45 degrees Fahrenheit before opening. The cork of a warm bottle is more likely to pop unexpectedly. 
  • Don’t shake the bottle. Shaking increases the speed at which the cork leaves the bottle, thereby increasing your chances of severe eye injury
  • To open the bottle safely, hold down the cork with the palm of your hand while removing the wire hood. Point the bottle at a 45-degree angle away from yourself and from any bystanders
  • Place a towel over the entire top of the bottle and grasp the cork
  • Keep the bottle at a 45-degree angle as you slowly and firmly twist the bottle while holding the cork to break the seal. Continue to hold the cork while twisting the bottle. Continue until the cork is almost out of the neck. Counter the force of the cork using slight downward pressure just as the cork breaks free from the bottle
  • Never use a corkscrew to open a bottle of champagne or sparkling wine

A cork can fly up to 50 miles per hour as it leaves the bottle, generating a force powerful enough to shatter glass. Eye-related cork injuries can lead to acute glaucoma, a detached retina, and/or corneal scarring, all of which can result in decreased vision. Follow these simple tips and have a safe and happy 2012!

Tuesday, December 27, 2011

Cataract surgery - What do I do after surgery?

Many people know someone who has had cataract surgery.  We frequently have patients who come to our ambulatory surgery center with a pre-conceived notion of how their recovery is going to limit their activities.  Not so!  Today, cataract surgery is performed using a small incision that will heal within a couple of days allowing patients to resume normal activities usually within one week.

After your surgery you will most likely have a patch and shield on your eye.  This is because your eye has been given an anesthetic to make it numb and the shield helps to protect it from becoming irritated or dry.  You will only need to wear it until late afternoon on the day of your surgery.  After you take it off you will start a series of eye drops that help to prevent swelling and infection as prescribed by your doctor. 

The eye shield will be worn over your eye at night for one week to help prevent possibly rubbing the eye or scratching it on your sheets. Some mild itching or discomfort may occur which is normal.  It is very important that you DO NOT rub your eye!  Tylenol is suggested as a pain reliever for any discomfort you may have. 

On the day of surgery, when you remove the shield at home, you may find that your eyesight is still somewhat blurry or you may experience double vision.  This is not unusual and is the result of a combination of the anesthetic agent and the dilating drops which were put into your eye before the surgery began.  This sensation should resolve over the course of the evening. 

You will be given a pair of sunglasses at your first surgery in the ambulatory surgery center.  These are designed for you to be able to wear over your glasses or shield.  They can still be worn after your recovery if you so desire.  If you are going to have cataract surgery on the other eye, we ask that you be sure to hang onto your glasses for use after that surgery.

Following your surgery you should not bend over with your head below your waist. That is, do not try to pick up anything from the floor as this can create pressure to your newly operated eye.  The bending and stooping restriction will be reevaluated at your follow up appointment with your surgeon the next day, but usually you are allowed to resume normal activities within a week.

You should refrain from any strenuous exercise or attempting to lift heavy objects that may cause you to strain or "bear down" for approximately 10 days.  However, you may go up and down stairs, read or watch T.V.  

When you shower do not let water into your eyes either directly or from run off your head.  You may wade into a pool if you would like, but you will be asked to refrain from swimming or immersing your head under water for at least 10 days.

You should be able to drive within a day or two after your surgery, but ask your doctor for his recommendation!

You will be using eye drops for about a month after the surgery to ensure that your eye heals completely.
It is important to remember that everyone and every eye is unique and your healing time may vary. 
Guest Blogger
Katie Guglietta R.N., ASC Manager with the Baltimore Washington Eye Center

Monday, December 26, 2011

The most comfortable eyewear

A patient told me last week that the new Maui Jim sunglasses we recently fit him with were "the most comfortable eyeglasses" he had ever had. Looked good to boot.

Thursday, December 22, 2011

Diabetic Eye Problems & Complications

Over time diabetes can damage the small blood vessels of the body. This is the underlying etiology for diabetic retinopathy the most well known ocular complication of diabetes. Damage to these small blood vessels can cause bleeding on the retina, poor oxygen supply to the retina and possible retinal detachment and scarring. Evidence shows that good blood sugar control greatly reduces the risk of diabetic retinopathy and new injectable medications are effective in treating complications when they do occur.

Although diabetic retinopathy is the most well known, it is not the only ocular pathology for which diabetic patients are at risk. Because diabetes affects the blood supply it increases the risk of diseases with a vascular etiology. Retinal vein occlusions are more common in diabetic patients. Diabetic patients are also at greater risk of glaucoma and optic nerve swelling. Poor blood flow to the cranial nerves that innervate the eye muscles can increase the risk of muscle palsy in diabetics. Eye muscle palsies will manifest as sudden onset double vision. Elevated levels of blood glucose in diabetics increase the risk of cataract development.

Consistent blood sugar control long-term has been demonstrated to help decrease complications from diabetes. Yearly eye exams are a hallmark of good diabetic management. However, any unusual eye symptoms require prompt attention by your eye care provider.

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

Tuesday, December 20, 2011

Retinal Detachment

Symptoms of retinal detachment may include the presence of increased eye floaters, light flashes (especially in peripheral vision), blurred vision, a veil or curtain blocking your vision, or a sudden dramatic decrease of vision. Patients with these symptoms should contact their eye doctor immediately and be seen for an exam the same day if possible. This type of eye problem is considered an emergency. Therefore, treatment from an eye doctor should not be delayed. The sooner a retinal detachment is diagnosed, the better the chances of saving vision.

Retinal detachment can occur for various reasons. The most common cause is a blunt or penetrating injury to the eye. However, sometimes a retina detaches on its own without an underlying cause. Additional causes of retinal detachment may include:
  • Spontaneously (perhaps due to an underlying anatomic abnormality)
  • Posterior vitreous detachment  
  • Complication of cataract surgery
  • Extreme nearsightedness
  • Diabetes
  • Inflammatory disorder

Anyone can be at risk for retinal detachment since the most common cause is blunt or penetrating injury to the eye, which can occur in a variety of ways ranging from being poked in the eye with a finger or pen to being injured during an athletic event. Certain factors can increase your risk of developing retinal detachment, such as:

  • Age (24-45 years old)
  • Gender (males more common than females)
  • Trauma
  • Family history of detached retina
  • Myopia (nearsightedness)
  • Diabetic retinopathy
  • Retinal detachment in other eye
  • History of any intraocular surgery
  • Aphakia (absence of lens) or Pseudophakia (artificial implant after cataract surgery)
  • Connective tissue disorders such as Wagner’s disease
  • Sickle cell retinopathy
  • Severe retinopathy of prematurity (ROP)
Fortunately, over 90% of people who experience a detached retina are treated successfully. On occasion a second treatment is needed. However, it may take several months after the initial treatment to determine whether a second treatment is required. Since the most common cause of retinal detachment is injury to the eye, it is important to wear protective eyewear during all activities. If you participate in high impact sports such as football or hockey, make sure you wear a face mask that completely covers your eyes. If you have diabetes, control your blood sugar levels. If you are at risk for retinal detachment, avoid risk factors if possible. Always see your eye doctor at least once a year or as often as they recommend, especially if you are at risk for retinal detachment.

Thursday, December 15, 2011

Dry Eye and Omega 3 and 6 Fatty Acids

Dry eye is a chronic condition that occurs when the tears which naturally lubricate the ocular surface are either deficient in quantity or quality. A reduced tear film or a tear film that evaporates too quickly will result in irritated red eyes that may over water. The tear film aids the focusing of light so a poor tear film may result in blurred or variable vision. The tear film also contains proteins and enzymes that kill microbes helping to ward off infection. A compromised tear film creates an environment more prone to infection. The National eye institute of the National institutes of health states that "nearly five million Americans 50 years of age and older are estimated to have dry eye." Although new medications are available to treat this condition many of my patients over age 50 loathe to add anything new to the growing list of medications they take on a regular basis. Omega 3 and Omega 6 fatty acids, due to their anti- inflammatory properties, are showing promise in the long term treatment of chronic dry eye.

Omega 3 and 6 fatty acids can be found naturally in seafood such as salmon and anchovies. They may also be found in flax seed and walnuts. Vitamin supplements are also available. We recommend at least 2500 mg of Omega 3 and 6 fatty acids a day. Patients trying this more natural approach to dry eye therapy should commit to 3 months of consistent treatment before evaluating the efficacy of this treatment for them. Even when topical or oral medications are needed in the short term to ameliorate the symptoms of severe dry eye, omega 3 and 6 supplements may be useful in the long term management to reduce the risk of future exacerbations.

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

EyeSmart® public education website

The Internet is loaded with an overwhelming amount of medical information. However, how much of what you see and read is accurate? That's why the American Academy of Ophthalmology created EyeSmart®, a public education website where you can get accurate, MD-reviewed information about a wide range of topics regarding your eyes and their health. Check it out by going to

Wednesday, December 14, 2011


So the FDA has posted a brief new LASIK Video for patients.  If you want even more detail and the answers to your questions about LASIK you can visit or if you would like more personal answers visit us at or call our Baltimore Washington Eye Center LVC counselor @ 410/761-8258 so we can help you.

Tuesday, December 13, 2011

Macular Degeneration (AMD)

Macular degeneration is commonly referred to as age-related macular degeneration or AMD due its tendency to affect older adults. There are two types of macular degeneration: dry and wet. Dry Macular Degeneration occurs when small, yellowish deposits (drusen) begin accumulating beneath the macula. The drusen gradually break down the light-sensing cells within the macula. This break down leads to distorted vision in the eye.

Wet Macular Degeneration accounts for only 10 percent of all cases and occurs when abnormal blood vessels begin growing behind the retina, toward the macula. Typically, these abnormal blood vessels are tiny in size and leak blood and fluid, damaging the macula and causing severe and rapid vision loss. Wet macular degeneration is much more severe than the dry form. Fortunately, over that past few years, treatment for wet macular degeneration has significantly advanced. New medicines have been developed to slow down and stop problematic blood vessels from forming. These new medicines are also known to improve treatment, which was not the case with earlier treatment methods. The medicines used are called anti-angiogenic or anti-vascular endothelial growth factor drugs. The two most common ones are Avastin and Lucentis. The medicine is injected into the eyeball and begins taking effect immediately, although injections are typically repeated every 1 to 2 months or until the disease is stabilized.

Prevention of macular degeneration includes reducing UV exposure, not smoking, and eating healthy diets of antioxidants and zinc.  Eating foods rich in Vitamins A, C and E could help reduce chances of developing this disease. To date, some studies have suggested a protective effect from lutein and zeaxanthin. In 2006, the National Eye Institute started the AREDS II study to further determine whether lutein and zeaxanthin (nutrients found in eggs and green vegetables) might indeed be protective against the disease. Exercising and keeping healthy are always good preventive methods for all diseases.

Additional ways to prevent Macular Degeneration include:
  • Wear sunglasses
  • Avoid alcohol when possible
  • Avoid all types of sugars when possible
  • Avoid excessive saturated fats and foods containing fats and oils that have been subjected to air or heat (lunch meats, hamburgers, fried foods, etc.)
  • Increase your consumption of legumes

Saturday, December 10, 2011

Amazing Vision with Astigmatism Implants

Forgot to mention a very happy patient we had this past week. She had suffered a previous retinal detachment requiring surgical repair. Subsequently, she developed a cataract. She was quite nearsighted with significant astigmatism in both eyes. She also had a smaller cataract in the eye that hadn't had a retinal surgery.

We decided to remove her cataracts and replace them with astigmatism(toric) correcting implants. We also gave her a modifed monovision, or blended vision, result. This would very likely enable her to use her computer without glasses as well as drive without glasses. Well, she is simply AMAZED at her result. One day after her second eye surgery last week, she asked "What did you do to my eye?" When I asked her what she meant, she said she not only could read the computer, she was seeing better than she had her entire life. Very satisfying moment for us to say the least. Pretty neat.

Corneal Crosslinking for Keratoconus

For decades, people suffering from advanced keratoconus had few options other than corneal transplant surgery, otherwise known as Penetrating Keratoplasty (PKP). Beyond the risks posed by the surgery itself, PKP patients face many months of healing and always carry the risk of transplant rejection. Researchers have long sought a means by which keratoconus and similar diseases might be stopped or even reversed; thereby reducing the need for invasive procedures like PKP

Since the late 1990's, and especially over the past several years, there has been an increasing body of evidence suggesting that applying riboflavin (Vitamin B2) to the human cornea followed by an application of ultraviolet (UV) light can stabilize diseases like keratoconus.  During this process, the UV light interacts with riboflavin to create more bonds between collagen molecules in the cornea. The increased bonds, or cross-linking, creates an increase in corneal strength.

In the US, there is an FDA phase III study underway. Hopefully, the study results will make corneal cross-linking (CXL) available to the general public before too long. While there are certain risks associated with CXL, the hope is that by treating keratoconus in its early stages, we can halt its progression, improve patients' vision, and reduce, if not eliminate, the need for PKP surgery. Eyewiki video of CXL

Friday, December 9, 2011

Intraocular Lens Implant Types

Intraocular Lens Implants or IOLs are artificial lenses that are used to replace natural lenses that have become clouded with Cataracts. They can also be used as a solution for people who suffer from presbyopia, a condition in which the lens becomes less flexible thus losing its ability to focus on near objects. There are a number of types of Intraocular Lens Implants (IOL) that can be used today. 

Monofocal Lens Implants (IOL) vs. Multifocal Lens Implants (IOL)

The traditional type of intraocular lenses are called Monofocal Lens Implants and are used to correct problems with distance vision leaving patients to rely on glasses or contacts for near vision. At Baltimore Washington Eye Center Drs. Betancourt and Spagnolo offer our patients Multifocal Lens Implants to help them see more clearly at a range of distances. This technology allows us to replace the eye’s natural lens with a new artificial lens that can help restore visual clarity to near, intermediate and distance vision.

Astigmatism Correcting Toric IOLs

If you have astigmatism, you may still experience blurred and distorted vision after traditional Cataract Surgery unless you wear eyeglasses because ordinary Monofocal IOLs cannot correct astigmatism. If freedom from glasses for distance vision is important to you, you now have a better option. The unique design of a toric IOL makes it possible to reduce or eliminate astigmatism and significantly improve uncorrected distance vision and may reduce or eliminate the need for corrective lenses for seeing at a distance for those patients who had astigmatism before their Cataract Surgery.

Spherical Aberration and Cataracts

Your eyes contain some imperfections called aberrations. An aberration is an irregularity in the shape of the eye's refractive surface that can distort vision. One type of common aberration is spherical aberration. Spherical aberrations are generally associated with:
  • Blurriness
  • Halos
  • Loss of contrast
  • Poor night vision
Drs. Betancourt and Spagnolo often implant an Aspheric Lens Implant designed to reduce spherical aberration and improve contrast sensitivity in order to help patients see better in low contrast environments such as for driving in dim illumination or during rainy, foggy times. Aspheric Lens Implants offer these advantages over traditional lens implants and some can even correct astigmatism.

Please feel free to schedule an appointment and contact us with your questions about Cataracts, Cataract Surgery or Lens Implants by calling Baltimore Washington Eye Center Toll Free at 800-495-3937.

Tuesday, December 6, 2011

Contact Lens-The EYE App Technology Advances

Advances in contact lens design have made lenses healthier, more comfortable and able to correct a wider array of vision problems. However, have you ever considered the other ways contact lenses can be used that have nothing to do with correcting vision?

For years contact lenses have been used to aid in the healing of corneal abrasions. Scratches on the surface of the eye will often heal on its own. However, every blink causes discomfort as the lid rubs over the abraded area. Additionally the mechanical force of the lid on the surface of the eye can make it more difficult for new cells to fill the area of the abrasion. Inserting a contact lens acts as a bandage protecting the delicate surface as it heals and improving patient comfort during the healing process.

Glaucoma is a complex disease whose etiology is a matter of debate. Although once thought to be the hallmark of glaucoma, elevated eye pressure is now known to be just one of the risk factors for this disease. As a matter of fact, some people with glaucoma never have a pressure outside of the normal range and some patients being treated for glaucoma with pressure lowering drops seem to progress in their disease despite having pressures measured in the office at adequate levels. The pressure reading done in the doctor’s office is merely a momentary snapshot of a dynamic pressure reading that likely fluctuates through the day and night. Sensimed, a Swiss company, has developed the Triggerfish electronic contact lens that can measure and record eye pressure readings for an entire day. This new information will likely prove invaluable for scientists as they strive to understand the true role of intraocular pressure in the diagnosis and management of glaucoma.

Delivering medications to the eye and having them absorbed effectively has always been a challenge. It has been estimated that "approximately 95% of the drug contained in the drops is lost due to absorption through the conjunctiva or through the tear drainage.”  Contact lenses impregnated with drugs have been used since the 1960s. However, the goal of continuous consistent sustained release of medication was difficult to achieve. Recent advances in contact lens materials and nano particle technology may make a commercially viable product a reality. An article reviewing the current state of these technologies notes that "The use of soft contact lenses for therapeutic drug delivery may correct three inherent deficiencies seen with the typical administration of eye drops into the eye: (i) the contact time of drug with the precorneal tear film may be longer; (ii) compliance as compared to frequent and complicated dosage regimens may be improved; and (iii) less systematic toxicity may be expected because of the total amount of drug administered compared to multidrops”.

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

Thursday, December 1, 2011

Sinus Problems and Vision Loss

We had an interesting case present to the eye clinic at Baltimore Washington Eye Center recently. The case involved a patient complaining of a blurred area in the vision of their right eye. The visual acuity was normal. However, while the patient did not complain of bulging eyes, upon exam it was clear that the right eye was protruding compared to the left eye. Furthermore, the right optic nerve was swollen.  The diagnosis was made following an MRI of the head and orbits. The patient’s condition turned out to be the result of sinus condition called a mucocele.
Mucoceles are cyst-like, expanding masses found in the sinus cavities.  Mucoceles are most commonly found in the frontal sinus, with the ethmoid and sphenoid sinuses involved less frequently.  The most common causes of mucoceles are chronic infection, allergic rhinitis, trauma, and previous surgery. Depending upon its location, a mucocele can cause a variety of symptoms including orbital pain, decreased visual acuity, visual field defects, exophthalmos (bulging eye), and problems with eye movement. Fortunately, mucoceles affecting the eye(s) are rare and when they do occur, endoscopic sinus surgery is an effective treatment for sinus mucoceles with a favorable long-term outcome. Our patient was referred to an Ear, Nose, and Throat specialist for surgical treatment. Here are several articles furthers detailing sinus mucoceles and the eye.