Eye Treatments & Procedures

WHAT IS A CATARACT?

A cataract is formed when the natural crystalline lens inside of the eye becomes cloudy, foggy and less transparent. The natural lens loses its ability to focus light on the retina. The proteins inside of the natural lens develop structural abnormalities, pigment changes, and becomes more rigid causing scattering of light onto the retina, causing blurred vision.

In addition, the natural lens can focus light onto the retina at different distances by changing its shape known as accommodation. Our ability to focus on varying distances especially near distances deteriorate as we develop cataracts.

WHAT CAUSES CATARACTS?

Most cataracts are due to the natural aging process hence the term “age-related cataracts”, but there are secondary causes of cataracts and risk factors that can accelerate the development of cataracts listed below.

  • Diabetes
  • Hypertension
  • Steroids (all forms: IV, oral, inhaler)
  • Smoking + Alcohol
  • UV light (living closer to the equator)
  • Trauma
  • Prior ocular surgery
  • Systemic disease (Atopic dermatitis, Myotonic dystrophy, Neurofibromatosis)
  • Radiation treatment
  • Family history or generic predisposition

WHAT ARE SYMPTOMS OF CATARACT?

Symptoms of cataract include the following:

  • Blurry vision (distance and/or near)
  • Glare & halos (around car headlights or street lights)
  • Difficulty driving at night
  • Decreased contrast sensitivity
  • Decreased color sharpness/brightness (colors are dull appearing)
  • Double vision in one eye
  • Difficulty with reading at near and intermediate distances
  • Difficulty reading street signs
  • New glasses prescription does not help
  • Increase in near-sightedness “second sight” (ability to read without glasses)

HOW ARE CATARACTS DIAGNOSED?

Cataracts are diagnosed when patients have a dilated eye exam or comprehensive eye exam. Usually, patients are seen by an optometrist first and then are referred to an ophthalmologist for preoperative cataract exam.

A preoperative exam consists of a comprehensive eye exam with some extra steps to prepare for cataract surgery.

HISTORY

The following infomation will be gathered during the exam.

  • Chief Complaint (CC),
  • History of Present Illness (HPI),
  • Past Medical History (PMHx),
  • Past Ocular History(POHx),
  • Past Surgical History (PSHx),
  • Medications,
  • Allergies.

This history will answer the questions:

  • Is the cataract opacity affecting your daily routine and activities?
  • Are you interested in surgery
  • Based on your medical history, are you a candidate for hospital-based surgery or outpatient surgery?
CO-EXISTING CONDITIONS
  • Patients with hypertension and diabetes need to have their blood sugar and blood pressure controlled the day of surgery.
  • Patients with recent Myocardia Infraction or heart attack may delay surgery for 6 to 12 months from date of incident.
  • Patients with recent Stroke or TIA may delay surgery for 6 to 12 months from date of incident.
  • Patient with Heart failure or COPD/Lung disease need to be able to lay flat or head mildly elevated for at least 30 minutes.
  • Patients with history of Hepatitis/HIV/infectious blood pathogens have special precautions to avoid needle stick injury.
  • Patients with dementia, Parkinson’s, tremors, epilepsy may require general anesthesia.
  • Patients with history or LASIK or PRK or other refractive procedures require more testing.
PATIENTS WHO WEAR CONTACT LENSES
  • Patients who wear soft contacts will need to be out of the lenses for 3 to 7 days.
  • Patients who wear hard contacts will need to be out of the lenses for 3 weeks.
ADDITIONAL TESTING

Additional testing may include the following:

  • Autorefraction: Device that measures refractive error.
  • Visual acuity testing: Best Corrected Visual Acuity (BCVA) with Manifest Refraction (Mrx).
  • Visual acuity with glasses or corrective lenses.
  • Glare Testing: Visual acuity with simulated glare (light source directed towards eyes).
  • Ocular vital signs.
  • Pupil response testing.
  • Intraocular (Eye) Pressure (Contact Tonometry).
  • Extraocular (Eye muscle) movements.
  • Confrontational Visual field testing .
  • Slit Lamp Exam (SLE) and Dilated Fundus Exam (DFE).
  • Biometry: Calculation of the intraocular lens and yields the most accurate postoperative refractive result after cataract surgery.
  • Keratometry: Measures anterior cornea curvature (steep or flatness) and power
  • Optical Biometry: Non-contact method to determine Axial length (eye length).
  • A-scan Ultrasonography: Contact method to determine Axial length (eye length from cornea to retina).
  • Optical Coherence Tomography (OCT): Noninvasive imaging device uses light to create cross section images of the retina and optic nerve. The machine detects optic nerve or retinal abnormalities that may affect vision. Used to rule out other eye diseases that affect vision other than cataracts.

WHAT IS THE TREATMENT FOR CATARACTS?

The treatment for cataracts is surgery which means removal of cataracts and placement of an intraocular lens.

At this present time there is no medical treatment for cataracts. This means there are not drops, oral, injections or other medications that can eliminate your cataracts.

In the United States there are two main forms of cataract surgery – phacoemulsification cataract surgery and femtosecond laser cataract surgery. The third form of surgery is called manual small incision cataract surgery (MSICS) typically used when cataracts are dense or difficult to remove with the traditional routes below.

PHACOEMULSIFICATION CATARACT SURGERY

Traditional cataract surgery involves the use of a blade to make one to two incisions into the cornea. This gives surgeon access to your cataract. Then the surgeon manually removes the anterior capsule (outer layer or wrapping paper of the cataract). Lastly the surgeon uses the phaco-ultrasonic hand device to fragment the lens in tiny pieces for easy removal.

FEMTOSECOND LASER CATARACT SURGERY

The surgeon uses femtosecond laser technology to make anterior cornea incisions, remove the anterior capsule (outer layer of cataract), soften the cataract lens, fragment the cataract lens, correct astigmatism with corneal incisions. The ultrasonic device is still used for final removal of cataract. The use of femto-laser can decrease the amount of ultrasound energy used to fragment and emulsify the cataract lens which can potential improve postoperative visual recovery.

WHAT ARE MY GOALS AFTER SURGERY?

The typical goal for cataract surgery is emmetropia, basically an eye with no refractive error. Usually, doctors aim for emmetropia or slightly myopic (-0.25 D to -0.50D) since it is well tolerated. Patients will usually need reading glasses after surgery.

Sometimes there are patients that want to be nearsighted, typically (-1.50D to -2.00D) depending on daily activities, after cataract surgery and prefer to wear glasses for distance.

Monovision: Patients who had previous refractive surgery or contact lenses where their dominant eye was corrected for distance and their non-dominant eye was corrected for near. Usually patients do not require glasses.

Some patients do not want glasses after surgery which may require a special intraocular lens known as a multifocal lens. Intraocular surgery involves placement of an artificial lens inside the eye.

TYPES OF ARTIFICIAL LENSES
  • Monofocal Lens: A lens with one focus point usually far distance. Patients will need glasses after surgery either for reading or distance vision depending on chosen focus point.
  • Toric Lens: An astigmatism corrective lens used to decrease/reduce post operative astigmatism after surgery.
  • Multifocal Lens: A lens with multiple focus points: distance, intermediate and near. Patients do not require glasses after surgery. These lenses are not covered by insurance and are out of pocket.

WHAT SHOULD I EXPECT AFTER CATARACT SURGERY?

EYE PROTECTION

After cataract surgery, patients are typically discharged from the facility with an eye shield, sometimes an eye patch, and surgical sunglasses.

EYE DROPS

Patients typically have one to three eye drops depending on the surgeon and facility protocols. These drops can include the following:

  • Antibiotic
  • Anti-inflammatory
  • Steroid
  • Eye Pressure Lowering
  • Combination Eyedrops (Antibiotic + Steroid + Anti-inflammatory all in one)
  • No Drops (if the patient had dropless cataract surgery)
TRANSPORTATION HOME

Patients need to have a person or home transportation service that will take them home and make sure they arrive home safely.

POST-OP INSTRUCTIONS

Please refer to your specific surgeon for details. Patients will have a post-operative instructions sheet with the drop frequency schedule and activities that should be limited including:

  • Keep the eye shield on until appointment.
  • Do not bend below the waist to pick up objects.
  • Do not swim or have your head underwater.
  • Do not rub or place pressure on the eye.
  • Do not lift anything weighing over 5 lbs.
  • Do not participate in sports or physical activity for a limited duration.
SEEK ATTENTION FOR POST-OP ISSUES

Patients will have a number to call if post-operative issues arise that require attention including:

  • moderate to severe eye pain
  • moderate to severe headache
  • decreased vision or loss of vision
  • severe bloodshot or red eye
  • new flashers or new floaters
POST-OP VISITS

Patients will have one to five postoperative visits and will have changing instructions and allowable activities.

  • Post Op Day 1 (1st eye)
  • Post Op Week 1 (1st eye)
  • Post Op Day 1 (2nd eye)
  • Post Op Week 1 (2nd eye)
  • Post Op Month 1

WHAT IS GLAUCOMA?

Glaucoma is a group of conditions that usually result in a specific type of optic nerve damage known as optic nerve cupping. Once significant optic nerve loss has occurred patients develop visual field loss in their peripheral vision which can progress centrally (“tunnel vision”).

Optic nerve damage and visual field loss is permanent. The optic nerve is the cable cord connecting the eye and the brain. Once the cord is damaged the brain has no signals resulting in vision loss.

Most of the time glaucoma is painless and patients do not have symptoms of vision loss until late in the end-stage of the disease. Early detention and treatment of glaucoma helps in preventing further damage and visual field loss.

WHAT ARE THE RISK FACTORS FOR GLAUCOMA?

Risk factors for glaucoma include the following:

  • Older age
  • Family History
  • African, Hispanic, or Asian ethnicity
  • Thin Cornea thickness
  • Elevated Eye pressure
  • Myopia (near sighted)
  • Hyperopia (far sighted) for Narrow angle glaucoma
  • Use of Steroids (oral, IV, inhaler)
  • Eye Trauma
  • Hypertension (high blood pressure)
  • Hypotension (low blood pressure)
  • Diabetes
  • Migraines, Vascular spasm, Raynaud’s phenomenon
  • Sleep Apnea

WHAT ARE THE SYMPTOMS OF GLAUCOMA?

Most patients with glaucoma will not have any symptoms in the early stages of the disease.

Patients with advanced stage glaucoma will have tunnel vision and issues with peripheral vision.

Patients with angle closure glaucoma will have symptoms of:

  • eye pain
  • red eye
  • headache
  • nausea and vomiting
  • decreased vision
  • loss of vision

WHAT ARE THE TWO MAIN TYPES OF GLAUCOMA?

OPEN ANGLE GLAUCOMA

Patients have open angle glaucoma when their drainage system, the trabecular meshwork, is open, unobstructed, and visible on exam. Glaucoma results from the resistance to outflow and the build up of eye pressure.

NARROW ANGLE OR ANGLE CLOSURE GLAUCOMA

Angle closure glaucoma occurs when the drainage system of the eye, the trabecular meshwork, is blocked or obstructed (usually by the iris) and fluid can not drain from the eye resulting in increased eye pressure.

HOW IS GLAUCOMA DIAGNOSED?

Glaucoma is diagnosed during a comprehensive eye exam. It may take a couple of visits and special testing to determine if a patient has glaucoma.

WHAT CAN I EXPECT DURING THE GLAUCOMA EXAM?
  • History
  • Visual acuity testing
  • Ocular vital signs
  • Eye pressure
  • Pupil testing: Confrontational fields, Extraocular movements
  • Slit Lamp Exam & Dilated Eye Exam
  • Fundus Photos of the optic nerve.
  • Gonioscopy (special lens placed on eye): determines if you have narrow angles or open angles.
  • Humphrey visual field: a device that measures and maps a patient’s visual field.
  • Optical Coherence Tomography: a noninvasive device that uses light to create cross section images of the optic nerve. It detects changes in optic nerve thickness over time and compares the patient’s optic nerve to their normal cohort.
FOLLOW-UP APPOINTMENTS

Patients with glaucoma are typically followed between every 2 to 6 months depending on the severity. Sometimes patients are followed for shorter duration, 1 to 8 weeks, depending on their ocular situation and response to treatment.

WHAT ARE THE TREATMENTS FOR GLAUCOMA?

MEDICATIONS

The initial treatment for glaucoma is topical medication. Some medication reduces aqueous humor production and others increase outflow of the drainage system.

  • Prostaglandin Analogs
  • BetaBlockers
  • Alpha agonists
  • Carbonic Anhydrase Inhibitors (topical and oral)
  • Rho-Kinase Inhibitors
  • Cholinergic Agents
LASER PROCEDURES
  • Laser Iridotomy: A procedure for patients with narrow angles/ narrow angle glaucoma. The laser creates a hole in the peripheral iris to prevent pupillary block and acute angle closure glaucoma.
  • Laser Trabeculoplasty: A procedure for patients with open angle glaucoma, who have issues taking eye drops (compliance or allergy). The laser targets the Trabecular meshwork for 180 to 360 degrees depending on the surgeon. This procedure improves outflow to reduce eye pressure. The effect of the laser can last up to 1 to 5 years and can be repeated, but loses its effectivity over time.
GLAUCOMA SURGERY
  • Traditional Glaucoma Surgery
    • Trabeculectomy: A procedure where a tiny scleral flap is created to improve outflow in glaucoma patients. This surgery creates a filtration bleb or conjunctival buble under the eyelid.
    • Glaucoma Drainage Device: A procedure where a tube implant is placed inside the eye (anterior chamber) to improve outflow. This tube is connected to a reservoir plate that will be sutured in between a patient’s eye muscles.
  • Minimally Invasive Glaucoma Surgery

WHAT IS LASER IRIDOTOMY?

Laser Iridotomy is the prophylaxis treatment for narrow angles and treatment for acute closure glaucoma.

WHO IS A CANDIDATE FOR LASER IRIDOTOMY

Patients with narrow angle glaucoma and acute angle glaucoma are candidates for laser iridotomy.

WHAT ARE NARROW ANGLE AND ACUTE ANGLE GLAUCOMA?

There is an angle formed between the iris and posterior cornea. When this angle is narrow, this is referred to as narrow angle glaucoma. With narrow angle glaucoma, the iris is appositional against the trabecular meshwork (TM), which is the drainage system of the eye, usually for 180 degrees.

Patients with narrow angle glaucoma are at risk for acute angle closure glaucoma. Acute angle closure occurs when there is sudden angle closure (usually from pupillary block) and the iris is covering the trabecular meshwork (TM).

After angle closure, there is a rapid rise in eye pressure which is a medical emergency!

WHAT ARE THE SYMPTOMS OF ACUTE ANGLE CLOSURE GLAUCOMA?

With acute angle closure glaucoma, patients experience acute/sudden

  • eye pain,
  • red eye,
  • headaches (usually one-sided),
  • nausea and/or vomiting,
  • decreased vision, loss of vision, decreased vision, blurred vision, photophobia (light sensitivity), tenders (ocular).

Narrow angle patients are at risk of pupillary block and acute angle closure patients suffered pupillary block. Pupillary block occurs when your iris is stuck against the anterior lens at the pupil border in your eye. This blocks the natural pathway and drainage of aqueous humor (intraocular fluid).

Pupillary block can lead to further narrow angling and appositional closure of the iris against the Trabecular meshwork (TM) leading to extremely high eye pressures which is a medical emergency.

Laser iridotomy creates a hole in the peripheral iris, which allows an alternate route for aqueous humor therefore bypassing the pupil. When aqueous is able to enter the anterior chamber the iris move back to its natural position (not against the TM) and aqueous can drain out of the eye.

Laser iridotomy is an outpatient procedure that can be performed in the office.

Laser Trabeculoplasty (LTP) is a outpatient office procedure for patients with open angle glaucoma. It serves as a primary (first-line) therapy or adjunctive therapy (used with topical glaucoma medication, eye drops).

LTP can lower eye pressure (IOP) up to 30%. The effect of LTP is temporary (lasts month to years) and not permeant (not curative) therefore patients need to follow up with their providers for future treatment options.

LTP has the potential to last 3 to 5 years for some patients but has decreased efficiency after each passing year after initial treatment.

The laser targets the pigmented drainage system of the eye, the trabecular meshwork (TM). The laser treatment is usually performed with argon, diode, double-frequency neodymium: yttrium-aluminum-garnet (Nd:YAG).

This laser procedure is usually recommend if patients cannot tolerate some eye drops, never used topical medication, inconsistent use of topical medication, or are on maximum topical treatment for glaucoma.

YAG capsulotomy is a specialized laser procedure that aims to address a common occurrence following cataract surgery called posterior capsule opacification (PCO). PCO can lead to a gradual clouding of the vision, resembling the symptoms of cataracts. At Peachtree Ophthalmology, we offer YAG capsulotomy as an effective solution to restore clarity and enhance visual acuity.

HOW YAG CAPSULOTOMY WORKS?

After cataract surgery, a clear artificial lens, known as an intraocular lens (IOL), is implanted to replace the cloudy natural lens. Over time, some patients may experience PCO, where the capsule behind the IOL becomes thickened and cloudy. This can cause a decline in vision, similar to the initial symptoms of cataracts.

During YAG capsulotomy, a laser is used to create a small, painless opening in the cloudy posterior capsule. This opening allows light to pass through and reach the retina, restoring clear vision. The procedure is quick, typically lasting only a few minutes, and patients often notice an immediate improvement in their vision.

BENEFITS OF YAG CAPSULOTOMY:

  • Improved Vision: YAG capsulotomy effectively addresses the clouding that can occur after cataract surgery, providing patients with clearer and sharper vision.
  • Non-Invasive Procedure: The laser procedure is non-invasive and does not require surgical incisions. It is performed in an outpatient setting, and patients can return to their normal activities shortly after.
  • Quick and Painless: YAG capsulotomy is a quick and painless procedure. Most patients experience minimal discomfort, and anesthesia is not typically needed.
  • Long-Lasting Results: Once the cloudy capsule is treated with YAG capsulotomy, the results are generally long-lasting, with no need for further interventions.

If you are experiencing vision changes after cataract surgery or suspect you may have PCO, contact Peachtree Ophthalmology at 770-285-7910 to schedule a consultation.  Don’t let cloudy vision persist – explore the benefits of YAG capsulotomy and regain the clarity you deserve.

Cataract

WHAT IS A CATARACT?

A cataract is formed when the natural crystalline lens inside of the eye becomes cloudy, foggy and less transparent. The natural lens loses its ability to focus light on the retina. The proteins inside of the natural lens develop structural abnormalities, pigment changes, and becomes more rigid causing scattering of light onto the retina, causing blurred vision.

In addition, the natural lens can focus light onto the retina at different distances by changing its shape known as accommodation. Our ability to focus on varying distances especially near distances deteriorate as we develop cataracts.

WHAT CAUSES CATARACTS?

Most cataracts are due to the natural aging process hence the term “age-related cataracts”, but there are secondary causes of cataracts and risk factors that can accelerate the development of cataracts listed below.

  • Diabetes
  • Hypertension
  • Steroids (all forms: IV, oral, inhaler)
  • Smoking + Alcohol
  • UV light (living closer to the equator)
  • Trauma
  • Prior ocular surgery
  • Systemic disease (Atopic dermatitis, Myotonic dystrophy, Neurofibromatosis)
  • Radiation treatment
  • Family history or generic predisposition

WHAT ARE SYMPTOMS OF CATARACT?

Symptoms of cataract include the following:

  • Blurry vision (distance and/or near)
  • Glare & halos (around car headlights or street lights)
  • Difficulty driving at night
  • Decreased contrast sensitivity
  • Decreased color sharpness/brightness (colors are dull appearing)
  • Double vision in one eye
  • Difficulty with reading at near and intermediate distances
  • Difficulty reading street signs
  • New glasses prescription does not help
  • Increase in near-sightedness “second sight” (ability to read without glasses)

HOW ARE CATARACTS DIAGNOSED?

Cataracts are diagnosed when patients have a dilated eye exam or comprehensive eye exam. Usually, patients are seen by an optometrist first and then are referred to an ophthalmologist for preoperative cataract exam.

A preoperative exam consists of a comprehensive eye exam with some extra steps to prepare for cataract surgery.

HISTORY

The following infomation will be gathered during the exam.

  • Chief Complaint (CC),
  • History of Present Illness (HPI),
  • Past Medical History (PMHx),
  • Past Ocular History(POHx),
  • Past Surgical History (PSHx),
  • Medications,
  • Allergies.

This history will answer the questions:

  • Is the cataract opacity affecting your daily routine and activities?
  • Are you interested in surgery
  • Based on your medical history, are you a candidate for hospital-based surgery or outpatient surgery?
CO-EXISTING CONDITIONS
  • Patients with hypertension and diabetes need to have their blood sugar and blood pressure controlled the day of surgery.
  • Patients with recent Myocardia Infraction or heart attack may delay surgery for 6 to 12 months from date of incident.
  • Patients with recent Stroke or TIA may delay surgery for 6 to 12 months from date of incident.
  • Patient with Heart failure or COPD/Lung disease need to be able to lay flat or head mildly elevated for at least 30 minutes.
  • Patients with history of Hepatitis/HIV/infectious blood pathogens have special precautions to avoid needle stick injury.
  • Patients with dementia, Parkinson’s, tremors, epilepsy may require general anesthesia.
  • Patients with history or LASIK or PRK or other refractive procedures require more testing.
PATIENTS WHO WEAR CONTACT LENSES
  • Patients who wear soft contacts will need to be out of the lenses for 3 to 7 days.
  • Patients who wear hard contacts will need to be out of the lenses for 3 weeks.
ADDITIONAL TESTING

Additional testing may include the following:

  • Autorefraction: Device that measures refractive error.
  • Visual acuity testing: Best Corrected Visual Acuity (BCVA) with Manifest Refraction (Mrx).
  • Visual acuity with glasses or corrective lenses.
  • Glare Testing: Visual acuity with simulated glare (light source directed towards eyes).
  • Ocular vital signs.
  • Pupil response testing.
  • Intraocular (Eye) Pressure (Contact Tonometry).
  • Extraocular (Eye muscle) movements.
  • Confrontational Visual field testing .
  • Slit Lamp Exam (SLE) and Dilated Fundus Exam (DFE).
  • Biometry: Calculation of the intraocular lens and yields the most accurate postoperative refractive result after cataract surgery.
  • Keratometry: Measures anterior cornea curvature (steep or flatness) and power
  • Optical Biometry: Non-contact method to determine Axial length (eye length).
  • A-scan Ultrasonography: Contact method to determine Axial length (eye length from cornea to retina).
  • Optical Coherence Tomography (OCT): Noninvasive imaging device uses light to create cross section images of the retina and optic nerve. The machine detects optic nerve or retinal abnormalities that may affect vision. Used to rule out other eye diseases that affect vision other than cataracts.

WHAT IS THE TREATMENT FOR CATARACTS?

The treatment for cataracts is surgery which means removal of cataracts and placement of an intraocular lens.

At this present time there is no medical treatment for cataracts. This means there are not drops, oral, injections or other medications that can eliminate your cataracts.

In the United States there are two main forms of cataract surgery – phacoemulsification cataract surgery and femtosecond laser cataract surgery. The third form of surgery is called manual small incision cataract surgery (MSICS) typically used when cataracts are dense or difficult to remove with the traditional routes below.

PHACOEMULSIFICATION CATARACT SURGERY

Traditional cataract surgery involves the use of a blade to make one to two incisions into the cornea. This gives surgeon access to your cataract. Then the surgeon manually removes the anterior capsule (outer layer or wrapping paper of the cataract). Lastly the surgeon uses the phaco-ultrasonic hand device to fragment the lens in tiny pieces for easy removal.

FEMTOSECOND LASER CATARACT SURGERY

The surgeon uses femtosecond laser technology to make anterior cornea incisions, remove the anterior capsule (outer layer of cataract), soften the cataract lens, fragment the cataract lens, correct astigmatism with corneal incisions. The ultrasonic device is still used for final removal of cataract. The use of femto-laser can decrease the amount of ultrasound energy used to fragment and emulsify the cataract lens which can potential improve postoperative visual recovery.

WHAT ARE MY GOALS AFTER SURGERY?

The typical goal for cataract surgery is emmetropia, basically an eye with no refractive error. Usually, doctors aim for emmetropia or slightly myopic (-0.25 D to -0.50D) since it is well tolerated. Patients will usually need reading glasses after surgery.

Sometimes there are patients that want to be nearsighted, typically (-1.50D to -2.00D) depending on daily activities, after cataract surgery and prefer to wear glasses for distance.

Monovision: Patients who had previous refractive surgery or contact lenses where their dominant eye was corrected for distance and their non-dominant eye was corrected for near. Usually patients do not require glasses.

Some patients do not want glasses after surgery which may require a special intraocular lens known as a multifocal lens. Intraocular surgery involves placement of an artificial lens inside the eye.

TYPES OF ARTIFICIAL LENSES
  • Monofocal Lens: A lens with one focus point usually far distance. Patients will need glasses after surgery either for reading or distance vision depending on chosen focus point.
  • Toric Lens: An astigmatism corrective lens used to decrease/reduce post operative astigmatism after surgery.
  • Multifocal Lens: A lens with multiple focus points: distance, intermediate and near. Patients do not require glasses after surgery. These lenses are not covered by insurance and are out of pocket.

WHAT SHOULD I EXPECT AFTER CATARACT SURGERY?

EYE PROTECTION

After cataract surgery, patients are typically discharged from the facility with an eye shield, sometimes an eye patch, and surgical sunglasses.

EYE DROPS

Patients typically have one to three eye drops depending on the surgeon and facility protocols. These drops can include the following:

  • Antibiotic
  • Anti-inflammatory
  • Steroid
  • Eye Pressure Lowering
  • Combination Eyedrops (Antibiotic + Steroid + Anti-inflammatory all in one)
  • No Drops (if the patient had dropless cataract surgery)
TRANSPORTATION HOME

Patients need to have a person or home transportation service that will take them home and make sure they arrive home safely.

POST-OP INSTRUCTIONS

Please refer to your specific surgeon for details. Patients will have a post-operative instructions sheet with the drop frequency schedule and activities that should be limited including:

  • Keep the eye shield on until appointment.
  • Do not bend below the waist to pick up objects.
  • Do not swim or have your head underwater.
  • Do not rub or place pressure on the eye.
  • Do not lift anything weighing over 5 lbs.
  • Do not participate in sports or physical activity for a limited duration.
SEEK ATTENTION FOR POST-OP ISSUES

Patients will have a number to call if post-operative issues arise that require attention including:

  • moderate to severe eye pain
  • moderate to severe headache
  • decreased vision or loss of vision
  • severe bloodshot or red eye
  • new flashers or new floaters
POST-OP VISITS

Patients will have one to five postoperative visits and will have changing instructions and allowable activities.

  • Post Op Day 1 (1st eye)
  • Post Op Week 1 (1st eye)
  • Post Op Day 1 (2nd eye)
  • Post Op Week 1 (2nd eye)
  • Post Op Month 1

Glaucoma

WHAT IS GLAUCOMA?

Glaucoma is a group of conditions that usually result in a specific type of optic nerve damage known as optic nerve cupping. Once significant optic nerve loss has occurred patients develop visual field loss in their peripheral vision which can progress centrally (“tunnel vision”).

Optic nerve damage and visual field loss is permanent. The optic nerve is the cable cord connecting the eye and the brain. Once the cord is damaged the brain has no signals resulting in vision loss.

Most of the time glaucoma is painless and patients do not have symptoms of vision loss until late in the end-stage of the disease. Early detention and treatment of glaucoma helps in preventing further damage and visual field loss.

WHAT ARE THE RISK FACTORS FOR GLAUCOMA?

Risk factors for glaucoma include the following:

  • Older age
  • Family History
  • African, Hispanic, or Asian ethnicity
  • Thin Cornea thickness
  • Elevated Eye pressure
  • Myopia (near sighted)
  • Hyperopia (far sighted) for Narrow angle glaucoma
  • Use of Steroids (oral, IV, inhaler)
  • Eye Trauma
  • Hypertension (high blood pressure)
  • Hypotension (low blood pressure)
  • Diabetes
  • Migraines, Vascular spasm, Raynaud’s phenomenon
  • Sleep Apnea

WHAT ARE THE SYMPTOMS OF GLAUCOMA?

Most patients with glaucoma will not have any symptoms in the early stages of the disease.

Patients with advanced stage glaucoma will have tunnel vision and issues with peripheral vision.

Patients with angle closure glaucoma will have symptoms of:

  • eye pain
  • red eye
  • headache
  • nausea and vomiting
  • decreased vision
  • loss of vision

WHAT ARE THE TWO MAIN TYPES OF GLAUCOMA?

OPEN ANGLE GLAUCOMA

Patients have open angle glaucoma when their drainage system, the trabecular meshwork, is open, unobstructed, and visible on exam. Glaucoma results from the resistance to outflow and the build up of eye pressure.

NARROW ANGLE OR ANGLE CLOSURE GLAUCOMA

Angle closure glaucoma occurs when the drainage system of the eye, the trabecular meshwork, is blocked or obstructed (usually by the iris) and fluid can not drain from the eye resulting in increased eye pressure.

HOW IS GLAUCOMA DIAGNOSED?

Glaucoma is diagnosed during a comprehensive eye exam. It may take a couple of visits and special testing to determine if a patient has glaucoma.

WHAT CAN I EXPECT DURING THE GLAUCOMA EXAM?
  • History
  • Visual acuity testing
  • Ocular vital signs
  • Eye pressure
  • Pupil testing: Confrontational fields, Extraocular movements
  • Slit Lamp Exam & Dilated Eye Exam
  • Fundus Photos of the optic nerve.
  • Gonioscopy (special lens placed on eye): determines if you have narrow angles or open angles.
  • Humphrey visual field: a device that measures and maps a patient’s visual field.
  • Optical Coherence Tomography: a noninvasive device that uses light to create cross section images of the optic nerve. It detects changes in optic nerve thickness over time and compares the patient’s optic nerve to their normal cohort.
FOLLOW-UP APPOINTMENTS

Patients with glaucoma are typically followed between every 2 to 6 months depending on the severity. Sometimes patients are followed for shorter duration, 1 to 8 weeks, depending on their ocular situation and response to treatment.

WHAT ARE THE TREATMENTS FOR GLAUCOMA?

MEDICATIONS

The initial treatment for glaucoma is topical medication. Some medication reduces aqueous humor production and others increase outflow of the drainage system.

  • Prostaglandin Analogs
  • BetaBlockers
  • Alpha agonists
  • Carbonic Anhydrase Inhibitors (topical and oral)
  • Rho-Kinase Inhibitors
  • Cholinergic Agents
LASER PROCEDURES
  • Laser Iridotomy: A procedure for patients with narrow angles/ narrow angle glaucoma. The laser creates a hole in the peripheral iris to prevent pupillary block and acute angle closure glaucoma.
  • Laser Trabeculoplasty: A procedure for patients with open angle glaucoma, who have issues taking eye drops (compliance or allergy). The laser targets the Trabecular meshwork for 180 to 360 degrees depending on the surgeon. This procedure improves outflow to reduce eye pressure. The effect of the laser can last up to 1 to 5 years and can be repeated, but loses its effectivity over time.
GLAUCOMA SURGERY
  • Traditional Glaucoma Surgery
    • Trabeculectomy: A procedure where a tiny scleral flap is created to improve outflow in glaucoma patients. This surgery creates a filtration bleb or conjunctival buble under the eyelid.
    • Glaucoma Drainage Device: A procedure where a tube implant is placed inside the eye (anterior chamber) to improve outflow. This tube is connected to a reservoir plate that will be sutured in between a patient’s eye muscles.
  • Minimally Invasive Glaucoma Surgery

Laser Iridotomy

WHAT IS LASER IRIDOTOMY?

Laser Iridotomy is the prophylaxis treatment for narrow angles and treatment for acute closure glaucoma.

WHO IS A CANDIDATE FOR LASER IRIDOTOMY

Patients with narrow angle glaucoma and acute angle glaucoma are candidates for laser iridotomy.

WHAT ARE NARROW ANGLE AND ACUTE ANGLE GLAUCOMA?

There is an angle formed between the iris and posterior cornea. When this angle is narrow, this is referred to as narrow angle glaucoma. With narrow angle glaucoma, the iris is appositional against the trabecular meshwork (TM), which is the drainage system of the eye, usually for 180 degrees.

Patients with narrow angle glaucoma are at risk for acute angle closure glaucoma. Acute angle closure occurs when there is sudden angle closure (usually from pupillary block) and the iris is covering the trabecular meshwork (TM).

After angle closure, there is a rapid rise in eye pressure which is a medical emergency!

WHAT ARE THE SYMPTOMS OF ACUTE ANGLE CLOSURE GLAUCOMA?

With acute angle closure glaucoma, patients experience acute/sudden

  • eye pain,
  • red eye,
  • headaches (usually one-sided),
  • nausea and/or vomiting,
  • decreased vision, loss of vision, decreased vision, blurred vision, photophobia (light sensitivity), tenders (ocular).

Narrow angle patients are at risk of pupillary block and acute angle closure patients suffered pupillary block. Pupillary block occurs when your iris is stuck against the anterior lens at the pupil border in your eye. This blocks the natural pathway and drainage of aqueous humor (intraocular fluid).

Pupillary block can lead to further narrow angling and appositional closure of the iris against the Trabecular meshwork (TM) leading to extremely high eye pressures which is a medical emergency.

Laser iridotomy creates a hole in the peripheral iris, which allows an alternate route for aqueous humor therefore bypassing the pupil. When aqueous is able to enter the anterior chamber the iris move back to its natural position (not against the TM) and aqueous can drain out of the eye.

Laser iridotomy is an outpatient procedure that can be performed in the office.

Laser Trabeculoplasty

Laser Trabeculoplasty (LTP) is a outpatient office procedure for patients with open angle glaucoma. It serves as a primary (first-line) therapy or adjunctive therapy (used with topical glaucoma medication, eye drops).

LTP can lower eye pressure (IOP) up to 30%. The effect of LTP is temporary (lasts month to years) and not permeant (not curative) therefore patients need to follow up with their providers for future treatment options.

LTP has the potential to last 3 to 5 years for some patients but has decreased efficiency after each passing year after initial treatment.

The laser targets the pigmented drainage system of the eye, the trabecular meshwork (TM). The laser treatment is usually performed with argon, diode, double-frequency neodymium: yttrium-aluminum-garnet (Nd:YAG).

This laser procedure is usually recommend if patients cannot tolerate some eye drops, never used topical medication, inconsistent use of topical medication, or are on maximum topical treatment for glaucoma.

How To Contact Us

Our eye clinic is ideally located near the intersection of Holcomb Bridge Rd and Spalding Dr. We are close to Norcross GA, Duluth, Johns Creek, and Gwinnett County communities.

Address

4045 Wetherburn Way, Ste 1
Peachtree Corners, GA 30092

Phone & Fax

770-285-7910
770-609-8356

Office Hours

Mon - Fri: 8:00 a.m. to 5:00 p.m.
Sat & Sun: Closed

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