Search for tag: "glasses"
From Nathan Tanner on August 18th, 2015
If you’re unable to wear contacts or glasses, or just plain tired of them there are other options to help correct your vision. The obvious one is LASIK, which can not only improve vision but…
August 25th, 2015
Dr. Miller: You don't want to wear your glasses and you don't want to use contacts. Are there other options? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.
Dr. Miller: Today I'm here with Bala Ambati and he is a professor of ophthalmology here at the University of Utah. Bala, what's the story? If you don't want to wear glasses and you're sick of even trying contacts or you can't wear them for whatever reason are there other options?
Dr. Ambati: We now have options for patients at almost any age to get rid of the need for glasses or contact lenses. In the young adult population, I'd say between the ages of 20 and 45 the primary option of course is LASIK or laser vision correction. In patients that have very high near-sightedness we can do what's called and intraocular contact lens, placing a lens inside the eye between the iris and the lens.
Dr. Miller: Let's go back for a second. LASIK, so that's actually a laser that cuts into what, the cornea, the lens? What does it do?
Dr. Ambati: LASIK, laser vision correction relies on creating a flap within the front quarter of the cornea, laying that flap off to the side and then reshaping the remaining cornea, the bed of the cornea, and then putting the flap back on.
There are some patients who are very near-sighted who would not be candidates for LASIK because the amount of laser would be too much for their eye. And in that situation we can offer what's called the intraocular contact lens where you can actually go inside the eye and place a contact lens in between the iris, the colored part of the eye, and the lens, and that has also been around for several years and works very nicely for the very high near-sighted population.
Dr. Miller: Well, it sounds great that we can use Lasik in some people to relieve them of the need of glasses or contacts but are there any downsides to the LASIKs procedure?
Dr. Ambati: I would say that any time you consider doing surgery you should get a careful screening. You want to make sure you don't have something called keratoconus. We do cornea scans to look at the shape and thickness of the cornea. We'd want to see if you have any other eye problems inside the eye.
Dr. Miller: If you had keratoconus I'd suppose LASIKs would not be a procedure you would prefer.
Dr. Ambati: Yeah, I would definitely not do laser vision correction on a patient with keratoconus. It is important to remember that after age 40 the lens in the eye weakens just due to increasing wisdom and maturity and when that happens
Dr. Miller: What a nice way of putting that.
Dr. Ambati: When that happens, you start needing reading glasses. And so, if you have Lasik at age 22 or 23 you would need reading glasses at age 40. But if you never had LASIK, at age 40 you would need bifocals.
Dr. Miller: I see. That makes sense.
Dr. Ambati: Exactly. And then, as I mentioned, in the older population, in patients over 55 or 60, the options at that point to get rid of glasses or contacts would be what are called multifocal or accommodating lens implants. Lens implants that can be placed inside of the eye that can give both distance vision and near vision. That usually happens at the time of cataract surgery. And that's a wonderful technology that's come out in the last five or six years.
Dr. Miller: It sounds like we can customize vision internally now almost.
Dr. Ambati: Absolutely. Anything in the front of the eye, the cornea, the lens, we can reshape or replace and customize it based on the person's eyes and visual goals and lifestyle.
Dr. Miller: One question I had from a patient not too long ago was if you had LASIK surgery, does that prevent you from having cataract surgery later in life? Is that a problem?
Dr. Ambati: It doesn't prevent cataracts or any other eye condition. So if you have LASIK at 25 and you're going to get cataracts when you're 70 or macular degeneration when you're 90, those things are still going to happen. And you can still undergo the usual procedures for those.
Dr. Miller: What you mentioned is that LASIK is not for everybody. There are some patients that couldn't receive LASIK, you mentioned keratoconus was one of those conditions. You mentioned this intraocular lens implant. How often are you using that lens implant now as compared to LASIK surgery? Is that becoming more popular?
Dr. Ambati: I would say that in patients with more than eight or nine diopters of near-sightedness, the intraocular contact lens is probably a better option.
Dr. Miller: Are there more risks with intraocular lens implantation than with LASIK? And if not, do you expect the lens implantations to become more popular than LASIK at some point?
Dr. Ambati: Every surgery has risks. Because the intraocular contact lens involves going inside the eye, there is a higher risk of bleeding or infection inside the eye than laser vision correction which stays just on the surface of the eye. But that said, the risks are extremely low, less than 1%.
Dr. Miller: It sounds like the first you would recommend would be LASIK surgery and if the measurements for the cornea weren't quite right for that the next step would be recommending intraocular lens implants.
Dr. Ambati: First, I would talk to the patient and see what phase of their life they're in and what their visual goals and needs are. Somebody who is 70 years old is probably going to be better served with removing an early cataract and putting in a lens implant at that time. But in a patient who is between 21 and age 45 the best thing for their eyes would be LASIK, assuming they're a good candidate. And that's what we would screen for.
If they're not a good candidate because their cornea's too thin or their cornea's not the right shape then there are all of these options like PRK, lasers without the flap, intacs if they have keratoconus, or the ICL, the intraocular contact lens if they're a very high near-sighted or a stigmatism patient.
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The eyes stop growing when most people are in their twenties. By then, most people have a stable prescription for contact lenses or glasses if they need it. So if you suddenly notice your vision is…
August 18th, 2015
Dr. Miller: Your vision has been changing rapidly over time, could that be a problem with you cornea? We're going to talk about that next on Scope Radio, and I'm Dr Tom Miller.
Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr Tom Miller is on The Scope.
Dr. Miller: I'm here with Balamurali Ambati, and he's a professor of ophthalmology here at the University of Utah. And we're going to talk a bit about problems that arise with the cornea, which is the foremost part of the eye that faces the environment.
Dr. Ambati: The cornea is the front window of the eye, and it has layers to it. Even though it's very thin, it's only about 0.5mm thick, it has five different layers. And the two most common problems of the cornea are a condition called keratoconus, where the cornea changes from its normal spherical shape into more of a cone-like shape.
Dr. Miller: And it does this over time?
Dr. Ambati: And it does this over time. And usually it does this in the late teenage years, 20s and 30s. So it's a condition primarily of young adults who may know or report that the eye has been unstable and changing. Most people, the eye stops growing by age 20 or 21, and the prescription...
Dr. Miller: Like the bones almost.
Dr. Ambati: Exactly, the prescription is stable. But if someone's astigmatism is changing... Astigmatism is when the cornea is shaped more like a football than a perfect sphere. That can be an early sign of keratoconus, and patients might report needing to go from soft lenses to soft toric lenses, or to hard contact lenses. They might report increasing near-sightedness and increasing astigmatism over the course of years. And this is something that is often undiagnosed till late stages, and so if you do have an unstable refraction or fluctuating vision over time it would be wise to get a cornea scan with an ophthalmologist.
Dr. Miller: What's the difference between, as you mentioned, fluctuating eyesight and progressive worsening of vision? Can you give a definition of that? I know you mentioned that when we talked about keratoconus as a problem.
Dr. Ambati: In fluctuating vision, which can occur especially in Fuchs' Dystrophy, the vision is different between morning and afternoon. In progressive loss of vision over the course of years, people recognize that their vision was not as bad a year ago, or two years ago.
Dr. Miller: The end result of that would bet at some point perhaps the contacts and lenses are no longer are effective in changing the vision, would that be the end stage?
Dr. Ambati: That can occur. The end stage of keratoconus requires what is called a cornea transplant, to replace the cornea with a donated cornea from someone who's passed away and donated their eye. Fortunately now, in the last five years, we've really changed the management of keratoconus to where we can prevent advancement from mild or moderate keratoconus to advanced keratoconus.
With things like intacs, which are rings that are placed inside the cornea that provide structural support, they're essentially an under-wire for the cornea to change it from a cone to a sphere. As well as the emerging technology of cross-linking, where we use a laser to stiffen the cornea and prevent weakening of the cornea.
Dr. Miller: So there are different options in the treatment?
Dr. Ambati: Very much so.
Dr. Miller: So is this a hereditary problem?
Dr. Ambati: It is a hereditary problem with what's called variable penetrance. So if you have a first degree relative with it you're at a higher risk for it.
Dr. Miller: Somewhat like glaucoma.
Dr. Ambati: Indeed.
Dr. Miller: And so if someone has a family history of keratoconus should they seek out an ophthalmological examination and a cornea scan?
Dr. Ambati: I think that would be advisable if they have any significant near-sightedness or astigmatism. And certainly it would be advisable if they are considering LASIK. One of the things that we do at Moran Eye Center is to carefully screen patients coming in for potential LASIK or laser vision correction to make sure they don't have keratoconus or other cornea problems.
Dr. Miller: So just to be sure, if one has keratoconus does it always require a transplant or is there, as you said, variable stages of the development of the problem?
Dr. Ambati: It is definitely a spectrum of progression, and if we can catch it in the mild or moderate stage the goal would be to employ intacs, or cross-linking, or some of these other options to prevent the need for cornea transplant.
Dr. Miller: Are there any other problems with the cornea? I notice since the cornea is the forward facing part to the environment, UV radiation, sunlight, does that affect the cornea more so than other parts of the eye such as the lens or retina?
Dr. Ambati: Certainly patients who are exposed to a lot of sunlight and UV light can develop pterygium, which is a growth on the surface of the cornea.
Dr. Miller: So that's a result of UV exposure sometimes?
Dr. Ambati: Indeed. And the UV radiation can also damage the back layer of the cornea, which is the endothelium. And those cells are actually what's called post-mitotic, they can't replace themselves. And so that can contribute to a condition called Fuchs' Dystrophy, where the cells of the back of the cornea slowly die. And that does require a partial thickness cornea transplant, but not a full cornea transplant, just replacing the back layer of the cornea. And those two conditions, Fuchs' Dystrophy and keratoconus, are probably the two most common causes of needing a cornea transplant procedure.
Dr. Miller: So in summary, would it be advisable if one has a family history of either of these problems to probably seek an ophthalmologic examination sometime in their 20s, or perhaps if they are having changing vision or astigmatism?
Dr. Ambati: Yeah, if you have fluctuating vision it is advisable to see an ophthalmologist at any time of your life. If you have a family history of keratoconus, in your brothers, sisters or parents, I think it would be advisable to see an ophthalmologist in the early or mid 20s. And if you have a family history of Fuchs' Dystrophy, that usually presents itself in the 40s or 50s, so that would be the best time to present.
Dr. Miller: Untreated what would be the end result of this if it continues untreated?
Dr. Ambati: Without therapy you would eventually lose vision, your eye would become cloudy and scarred. But generally people come well before that.
Dr. Miller: Thank you very much.
Dr. Ambati: Thank you.
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