Pink Eye

Adenoviral conjunctivitis, more commonly known as “pink eye,” is a frequently encountered problem at Focal Point Vision. Adenovirus is present in the environment in over 40 subtypes, and can cause a variety of health problems including respiratory and gastrointestinal infections.

When adenovirus infects the eye, the patient notices redness, tearing, itching, irritation, crusting, and sometimes eyelid swelling. Typically the infection starts in one eye, then spreads to affect the other eye within a few days. Patients may also notice a tender lymph node in front of the ear on one or both sides. Often there is a history of recently having had an upper respiratory infection or of having a friend or family member with a red eye.

The examining ophthalmologist typically notices a “lumpy bumpy” appearance of the conjunctiva called “follicular conjunctivitis” and sometimes sees swollen conjunctiva (“chemosis”) or red patches caused by broken blood vessels (“subconjunctival hemorrhage”).

Certain subtypes of adenoviral conjunctivitis are particularly severe, causing additional symptoms and termed epidemic keratoconjunctivitis, or EKC. Patients with EKC are often light sensitive and have blurred vision because of a strong reaction by the immune system in the cornea. They can also have yellowish “pseudomembranes” that form on the insides of the eyelids.

Adenovirus is highly contagious and is spread by contact with the tears, so patients should wash their hands frequently and refrain from shaking hands with other people during the infection. Like the common cold, there is no treatment that reliably shortens the course of an adenoviral infection. Treatment is geared toward relieving symptoms, and usually consists of cool compresses and cold artificial tears. In more severe cases of EKC, topical and even oral steroids are sometimes necessary to reduce inflammation. If you have any questions on Pink Eye, or any eye issues contact Focal Point Vision today: 210-614-3600

DO CATARACTS COME BACK? — DR. ZACK BURKHART

Many patients ask, “After you remove my cataracts, will they come back?”

The short answer is no, but a patient’s vision can get cloudy again, even after perfect cataract surgery.  Here’s the explanation, courtesy of Dr. Zack Burkhart…

At the time of cataract surgery, the surgeon removes the patient’s cloudy lens from the lens capsule. This clear, thin-walled “bag” is preserved as the natural lens is removed so that the surgeon can place the new, artificial lens inside.

In a considerable fraction of patients who have had cataract surgery, the lens capsule starts to become cloudy due to the growth of cells called lens epithelial cells on the inside surface of the capsule. As these cells multiply and spread across the inner surface of the lens capsule, it begins to lose its clarity, acquiring a grayish, irregular haze. Ophthalmologists refer to this haziness of the lens capsule as “posterior capsular opacity” or “PCO.”

As this process takes place, the patient begins to notice gradual blurring of the vision in the involved eye, often accompanied by glare, starbursts, and halos around lights at night. These symptoms are often described as similar to the original cataract symptoms. Fortunately, PCO is a fairly simple problem to solve, thanks to the amazing capability of the YAG laser.

This laser, which is available to Focal Point doctors at all locations, can be focused on the posterior capsule and used to remove the hazy portion in a matter of seconds, without affecting any other part of the eye. The procedure is done quickly and easily in the office, causes no pain for the patient, and typically results in marked vision improvement within a few hours. Patients are free to return to normal activity after the procedure, and post-procedure medications are usually not needed. Once the patient has had the opacity removed with the YAG laser, it does not recur.

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.

GLAUCOMA: THE SILENT THIEF

What is glaucoma?

Glaucoma is a disease of the eye that can present in many different forms. In rare cases, it can be present at birth, but only about 1 in 15,000 newborns have congenital glaucoma. More commonly, glaucoma is a disease found in adults, especially in senior citizens. Glaucoma is a complex disease, but the main risk factor is high pressure inside the eye from either too much fluid or inadequate drainage of this fluid.  In any case, when there is too much pressure inside the eye, the pressure must be reduced by drops or surgery in order to prevent optic nerve damage and permanent loss of vision.

How can I tell if I have glaucoma?

Unfortunately, in most cases of glaucoma, there are no obvious signs or symptoms. High pressure rarely causes pain or blurry vision and this is the reason why glaucoma is referred to as the Silent Thief. Additionally, the early visual loss from glaucoma affects only our peripheral vision, and often the other eye can compensate.  We can have this type of vision loss for many years before we become aware of it. We may compensate for the loss by turning our heads more from side to side to see and not realize we are doing so. If it seems that cars are popping into view from out of nowhere, be suspicious, and tell your eye doctor. We are able to employ simple, painless tests in order to assess your risk of having glaucoma. Risk factors for glaucoma include advanced age, family history, autoimmune and inflammatory diseases, and prolonged steroid use .

How is glaucoma treated?

The majority of glaucoma patients are treated with daily pressure-lowering eye drops. In some cases, laser and surgical procedures are necessary in order to keep it under control. These laser and surgical procedures are available at Focal Point Vision and many can be performed in our office. As in most situations, an ounce of prevention is worth a pound of cure. The doctors at Focal Point Vision are highly trained and experienced in the diagnosis and treatment of all of the types of glaucoma. Beware the Silent Thief.

“”The only thing worse than being blind is having sight but no vision“…Helen Keller

By Dr. Jorge San Martín

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.

LIVE LIFE NOW WITH LASIK AND FACE YOUR #FOMO!

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.

 

THE GOLDEN RULE AT FOCAL POINT VISION

If you are reading this Blog you are most likely on the quest to find clearer vision. Be it cataract surgery, LASIK, Corneal Transplant or possibly Crosslinking for Keratoconus. You’ve searched online, asked your family and friends and exhausted all avenues you can think of to find the eye care provider to give you the care and results you’re after.

Now it’s time to make your decision, and it’s not one to take lightly. After all, it’s your eyesight we are talking about here.

At Focal Point Vision (FPV) we take your decision very seriously, and we know you’re asking the question, “Why should I go to FPV over all the other practices in the San Antonio area?” That’s a fair question, and my answer to you is, “The Golden Rule.”

“Do unto others, as you would have them do unto you.”

Pretty simple answer…right?

Words we live by at FPV…Absolutely!

Yes, our doctors at FPV are highly trained specialists, well respected in the community & around the globe, and are able to provide you with the care and clearer vision you seek.

Yes, we are affordable with the services and products we offer.

These are things you expect from us.

To have a great experience during your road to clearer vision and be treated with professionalism, respect and dignity…well…you deserve that from your eye care provider!

At FPV we put ourselves in our patients’ shoes, and our ultimate goal is to speak to you and serve you the exact same way that we expect to be spoken to and treated.

“The Golden Rule” is not just words spoken; rather they are the words we live by.

Please come visit us at FPV, and afterwards, share with me your experience. I feel confident you won’t be disappointed!

All the best,

Craig Lannom – Executive Director

Lannom@FocalPointVision.com

ALL ABOUT FLOATERS

One of the most common patient complaints is, “Doc why do I see floaters?”

What is a floater?

Floaters are tiny pieces of a protein called collagen. They are in the gel that fills the cavity of the eye – the Vitreous Gel.

We become aware of floaters when they are large enough to cast a shadow on to the retina and they appear as black dots, squiggly lines like cobwebs, or circular or oval shapes. These benign floaters are often seen while working on the computer or gazing at a blank surface.  They appear as little dots that move back and forth as one looks around.

Who gets floaters?

Anyone can have floaters at any age. They may be associated with eye trauma, infection, inflammation or commonly, just with advanced age. They can be seen in diabetics who may have bleeding inside the eye from abnormal blood vessels. They are sometimes seen in very nearsighted persons as well.

What is a Posterior Vitreous Detachment?

A common situation involving floaters may occur in older people, and it is called a Posterior Vitreous Detachment.  The vitreous gel deteriorates and contracts as we age. As it contracts, it may pull on the retina (the light-sensitive, inner layer of the eye). As the vitreous gel tugs on the retina, light flashes are often produced and floaters become more visible to us. This type of floater and or light flashes are of much greater concern than floaters we may have been aware of for years.

Vitreous detachment may lead to retinal detachment, and if the retina detaches there is a risk of permanent vision loss. For this reason, we should never assume that our floaters are benign.

We recommend that anyone seeing floaters for the first time should have a comprehensive dilated exam as soon as possible. If there is sudden blurred vision, cloudy vision, shadows or a curtain-like obstruction of vision, it is extremely important to call your eye doctor immediately.

Old Chinese Proverb: There is no such thing as a small hurt in the eye…

By Jorge San Martin, OD

CROSSLINKING AT FOCAL POINT VISION

What is Corneal Crosslinking?  Who is a good candidate for this treatment?

Crosslinking is a newly approved procedure that we use to stabilize abnormal corneas.  The most common condition we treat with crosslinking is called keratoconus, which is an inherited condition that leads to high astigmatism and blurry vision.  Another condition is called post-LASIK ectasia, which is a condition in which the cornea is weakened by too much surgery.

We have been performing corneal crosslinking at FPV for the last 5 years, first as a site in the FDA studies, and now after approval of the device.  We have treated over 75 patients, and the pace is increasing, as we have been treating over 10 eyes monthly since Fall 2016.  Also, we have held some continuing education programs for other doctors in the community to increase awareness about cross-linking.

It is important to know that cross linking is NOT the same as LASIK or PRK.  It is not refractive surgery, rather a procedure to strengthen a weak cornea.  It is not designed to improve vision so much as stabilize it.

Also, cross linking is performed in the office with mild sedation.  It takes about 1 hour to perform the procedure, and patients generally return to school or work 3 days after the procedure.  Usually there is some discomfort after the procedure, so that is one reason why we treat one eye at a time.  Additionally, the vision can be blurry for up to 3-4 weeks, another reason why we prefer treating the eyes sequentially.

In summary, we are happy to be leaders of corneal crosslinking in South Texas.  We have the most experience with this procedure, and our Lisa Navarro is standing by at 210-614-3600 to answer any questions you may have.  Please visit our page here to learn more about crosslinking and other treatments for keratoconus and corneal ectasia.

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.