What’s a Pterygium? By Dr. Daughtry

Pterygium or I Have a Ter-what?

A pterygium (ter-rij-ee-uhm) is a growth of fibrovascular tissue that starts on the conjunctiva of the eye and extends onto the corneal surface, often in a triangular or wing-like shape. It may grow very slowly in some individuals or rapidly in others. In the early stages there may be no symptoms and some patients may not even realize they have one. In later stages, however, the eye can become inflamed leading to discomfort  and an undesirable appearance, while its growth onto the cornea can cause blurred vision.

Treatment for mild cases may include artificial tears to lubricate the eye and/or steroid eye drops to calm active inflammation. For moderate to severe cases, surgical removal may be indicated. Historically, there has been a high rate of recurrence of pterygia following surgery, but removal combined with other treatments such as conjunctival autografts, amniotic membrane transplantation and the use of mitomycin C (a chemotherapeutic agent) have brought the recurrence rate down.

The prevalence of pterygia are higher near equatorial regions of the world and in high altitude populations, indicating a relationship to sunlight or ultraviolet exposure. They are also believed to be connected to dusty or windy environments. Wearing UV-protecting sunglasses and/or wide-brimmed hats can be helpful.

The doctors here at Focal Point Vision have the training and experience to treat your pterygium. Give us a call at 210-614-3600 or go to www.focalpointvision.com to schedule your exam.

WHAT IS THE DIFFERENCE BETWEEN CATARACT SURGERY AND LASIK?

At Focal Point Vision, our ophthalmologists, or eye surgeons, are fellowship-trained and perform both cataract and LASIK surgery. Often during the discussion of cataract surgery, a patient asks, “are you going to be doing LASIK on my eyes? What is the difference between cataract surgery and LASIK?”

Essentially, cataract surgery involves removal of the lens and placement of an artificial lens while LASIK involves reshaping of the cornea.

Before we discuss the nuances of each procedure, it is important to review the basic anatomy of the eye. As you can see in the picture below, the cornea is the clear, spherical “front” of the eye, analogous to the windshield of the car.  Behind the cornea is the iris, or colored part of the eye that can open and close depending on the amount of ambient light, and behind the iris is the lens.  The cornea and lens focus light to land on the retina, which works like the film in a camera, changing light into nerve impulses that travel to the brain.

 

Thus, we’re born with a clear crystalline lens that works very well when we are young, expanding and contracting to see both far and near without reading glasses.  Around the age of 45, the lens becomes more rigid and harder to flex, necessitating reading glasses.  As the number of birthday candles increases, the lens gets more rigid and cloudy, and when it becomes mostly cloudy, we call it a cataract. Cataract surgery is an exchange of the cloudy, dysfunctional natural lens with an artificial lens made of acrylic.

On the other hand, LASIK is eye surgery in which we use a laser to reshape the cornea and eliminate the need for glasses or contacts.

Again, cataract surgery involves exchange of the lens, while LASIK involves reshaping the cornea. Both procedures can change somebody’s refractive error, or “prescription,” and lessen the need for reading glasses.

LASIK is commonly performed in patients between the age of 20 – 40, while cataract surgery is more often performed in patients above the age of 55.

Over the past few years, we have started to use a LASIK femtosecond laser at the time of cataract surgery to make incisions, divide the cataract, and treat astigmatism. This is called “laser cataract surgery,” and we will address this in future posts.  Thanks!  James Lehmann, MD.

ANGLE CLOSURE GLAUCOMA BY DR. ZACK BURKHART

Angle closure glaucoma is a serious condition that can, if untreated, lead to permanent vision loss and even blindness. Patients who are at risk for this type of glaucoma have “narrow angles,” meaning the front fluid-filled compartment of the eye is particularly small. Such patients are often far-sighted, or “hyperopic” and at least 1/3 have a family history of a close relative with the condition.

An episode of “acute angle closure” in a patient like this can cause rapid elevation of the pressure inside the eye, with symptoms of a headache, eye pain, eye redness, blurred vision, nausea, and vomiting. Any person with these symptoms should alert an eye care professional as soon as possible, since prolonged elevation of eye pressure can cause severe and permanent damage to the eye.

Focal Point Vision doctors always assess the risk of angle closure glaucoma for each new patient they see, utilizing a variety of tools including special prisms called gonioscopy lenses and an imaging device called an anterior segment optical coherence tomographer (ASOCT). These examination tools help our doctors determine which patients might benefit from a preventative laser procedure known as Laser Peripheral Iridotomy (LPI).

Any patient having an “acute angle closure” episode, and those patients at high risk for such an episode, should have LPI performed. The procedure is done quickly in the office with minimal discomfort, excellent success rate, and extremely low risk to the patient. The laser procedure essentially removes the future risk of angle closure episodes, and should be performed on both eyes, since patients with narrow angles are typically at risk for glaucoma in both eyes. Narrow angle patients who also have cataracts are sometimes treated with cataract surgery, which eliminates the risk of angle closure glaucoma, and improves the vision at the same time.

Don’t hesitate to call 210-614-3600 and make an appointment with the doctors at Focal Point Vision if you or someone you love may have a risk of angle closure glaucoma.

DMEK SURGERY COMES TO SOUTH TEXAS!

We are proud to be the first practice in South and Central Texas to offer DMEK to patients with corneal edema from Fuch’s Dystrophy and other corneal diseases. Previously, patients interested in DMEK surgery would have to travel across the country to find a surgeon experienced in the newest technique in endothelial transplants, but now Texans can visit Drs. Kenneth Maverick and James Lehmann in San Antonio for this latest advancement in corneal transplantation.

What is DMEK? How does it differ from DSEK? Is it really any better?

DMEK stands for Descemet’s Membrane Endothelial Keratoplasty and involves precise anatomic replacement of the diseased part of the cornea. Over the last decade, DSEK has emerged as a significant advancement in corneal transplantation, and it is now performed more frequently than traditional transplants; however

in DSEK, the surgeon adds tissue to the recipient’s cornea, and while it is superior to a full-thickness transplant, there are some shortcomings.

Typically DSEK patients do not reach 20/20 vision, they have a shift in their glasses prescription, and require frequent drops to prevent rejection. The rate of rejection is better than that in traditional keratoplasty, but it occurs in approximately 10% of patients.

DMEK is the logical evolution of endothelial surgery, with better vision in a shorter recovery time, no change in a patient’s glasses prescription, and a lower rejection rate than DSEK.

We have performed DMEK in patients who have had successful DSEK surgery in their other eye, and every one prefers the vision in the DMEK eye over the DSEK eye, hands down.

If you have Fuch’s Dystrophy (with or without a cataract) and would like to make an appointment with Drs. Maverick and Lehmann, please call our office at 210-614-3600 and ask for Michelle Arevalos. Also, you can contact her at arevalos@focalpointvision.com.

CATARACTS – WHAT YOU SHOULD KNOW (PART 1)

What is a cataract?  

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans have either a cataract or have had cataract surgery. A cataract can occur in either or both eyes. It cannot spread from one eye to the other. 

What is the lens?

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye. (See diagram below.)

 

 

In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain. The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred. 

How do cataracts develop? 

Age-related cataracts develop in two ways: 

  1. Clumps of protein reduce the sharpness of the image reaching the retina. The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings. When a cataract is small, the cloudiness affects only a small part of the lens. You may notice changes in your vision. Cataracts tend to “grow” slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
  2. The clear lens slowly changes to a yellowish / brownish color, adding a brownish tint to vision. As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina. If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.

 

Who is at risk for cataract?  

The risk of cataract increases as you get older. Other risk factors for cataract include: 

  • Certain diseases (for example, diabetes).
  • Personal behavior (smoking, alcohol use).
  • The environment (prolonged exposure to ultraviolet sunlight).  

 

What are the symptoms of a cataract? 

The most common symptoms of a cataract are: 

  • Cloudy or blurry vision.
  • Colors seem faded.
  • Glare: Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
  • Poor night vision.
  • Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
  • Frequent prescription changes in your eyeglasses or contact lenses. 

 

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, call us at 210.614.3600 to schedule a cataract evaluation with one of our skilled surgeons.

CATARACTS – WHAT YOU SHOULD KNOW (PART 1)

What is a cataract?  

A cataract is a clouding of the lens in the eye that affects vision. Most cataracts are related to aging. Cataracts are very common in older people. By age 80, more than half of all Americans have either a cataract or have had cataract surgery. A cataract can occur in either or both eyes. It cannot spread from one eye to the other. 

What is the lens?

The lens is a clear part of the eye that helps to focus light, or an image, on the retina. The retina is the light-sensitive tissue at the back of the eye. (See diagram below.)

 

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In a normal eye, light passes through the transparent lens to the retina. Once it reaches the retina, light is changed into nerve signals that are sent to the brain. The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image you see will be blurred. 

How do cataracts develop? 

Age-related cataracts develop in two ways: 

  1. Clumps of protein reduce the sharpness of the image reaching the retina. The lens consists mostly of water and protein. When the protein clumps up, it clouds the lens and reduces the light that reaches the retina. The clouding may become severe enough to cause blurred vision. Most age-related cataracts develop from protein clumpings. When a cataract is small, the cloudiness affects only a small part of the lens. You may notice changes in your vision. Cataracts tend to “grow” slowly, so vision gets worse gradually. Over time, the cloudy area in the lens may get larger, and the cataract may increase in size. Seeing may become more difficult. Your vision may get duller or blurrier.
  2. The clear lens slowly changes to a yellowish / brownish color, adding a brownish tint to vision. As the clear lens slowly colors with age, your vision gradually may acquire a brownish shade. At first, the amount of tinting may be small and may not cause a vision problem. Over time, increased tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting may make it more difficult to read and perform other routine activities. This gradual change in the amount of tinting does not affect the sharpness of the image transmitted to the retina. If you have advanced lens discoloration, you may not be able to identify blues and purples. You may be wearing what you believe to be a pair of black socks, only to find out from friends that you are wearing purple socks.

 

Who is at risk for cataract?  

The risk of cataract increases as you get older. Other risk factors for cataract include: 

  • Certain diseases (for example, diabetes).
  • Personal behavior (smoking, alcohol use).
  • The environment (prolonged exposure to ultraviolet sunlight).  

 

What are the symptoms of a cataract? 

The most common symptoms of a cataract are: 

  • Cloudy or blurry vision.
  • Colors seem faded.
  • Glare: Headlights, lamps, or sunlight may appear too bright. A halo may appear around lights.
  • Poor night vision.
  • Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)
  • Frequent prescription changes in your eyeglasses or contact lenses. 

 

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, call us at 210.614.3600 to schedule a cataract evaluation with one of our skilled surgeons.