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April 1, 2008

LASIK and Glaucoma

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LASIK patients have faced an elevated risk of vision loss from glaucoma, but that may be changing. LASIK does not cause glaucoma but can interfere with detection of the condition. Early detection plays a critical role in preserving eyesight. Since glaucoma does not present symptoms in the early stages it can only be discovered during an eye exam.

Glaucoma causes damage to the optic nerve which eventually leads to vision loss. Normally this damage is caused by high intraocular pressure (IOP). The standard method of initial detection of glaucoma is to test IOP. The problem with this method is that people with thin corneas will test with a lower IOP than they really have, leading doctors to believe that they do not have glaucoma. A few people have naturally thin corneas, and LASIK surgery thins the cornea.

It is not uncommon to develop glaucoma in the later years of life. With LASIK vision correction becoming more popular, the fear is that in a few years glaucoma will go undetected on a regular basis. This inaccurate form of testing may also lead to a false spike in “normal pressure” glaucoma.

In early 2005 the Food and Drug Administration approved a device called the TonoPach which measures both IOP and corneal thickness simultaneously in order to produce a more accurate reading.

If you have had LASIK surgery you must discuss it with your ophthalmologist before your eye exam and make sure that he or she is equipped to test IOP and corneal thickness together.

LASIK surgery if you already have glaucoma.
IOP is drastically increased during the LASIK procedure. For this reason, glaucoma patients may not make good LASIK candidates. Some ophthalmologists will recommend against LASIK for anyone with glaucoma. Many will recommend PRK as an alternative since it does not raise IOP as much as LASIK.

In reality, having glaucoma does not necessarily mean that you cannot have LASIK. Patients with mild glaucoma or who have their IOP under control with medications can still make good candidates for the procedure. If you have glaucoma and refractive error look for an ophthalmologist who has experience with LASIK procedures for glaucoma patients to find out if you are a good candidate and if not which alternatives may be right for you. Your ophthalmologist will need to determine the health of your optic nerve before making a recommendation.

Glaucoma patients must have their IOP measured on a regular basis. After LASIK measurements will need to be taken in a manner that adjusts for a thinner cornea. If you change doctors you must always tell your new doctor that you have had LASIK surgery so that he or she can measure your IOP properly.

LASIK is a wonderful option for correcting refractive error. As new technology emerges, the long term outlook for LASIK patients becomes even better. Just like any other surgery or procedure you may have, you should always talk openly with your doctor if you have had LASIK and discuss any concerns that you may have.

If you are considering LASIK surgery, contact an experienced ophthalmologist such as Dr. Stuart Lewis of Denver, Colorado.

Articles about other vision disorders : Secondary Glaucoma, Acute Angle Glaucoma, Glaucoma Risk Factors, Diabetes and Glaucoma, Lasik and Glaucoma, What Everyone Should Know About Glaucoma, Diabetic Eye Disease, Dry Eye, Amblyopia, Macular Degeneration, Computer Vision Syndrome, Cataracts, Cancer of the Eye, Keratoconus, and Epithelial and Stromal Dystrophies.

LASEK - Laser Vision Correction.

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Are You a Candidate for LASEK?
LASEK (or Laser Assisted Sub-Epithelial Keratectomy) is a suitable alternative when corneal shape or thickness makes the risk of LASIK unacceptable. Compared to LASIK, there is also less risk since there is no flap created, but there is a slightly longer healing and visual recovery period.

LASEK is relatively new and is only performed by select laser vision correction surgeons. Ophthalmologists, such as those in the Clear Advantage Laser Center in Portsmouth, New Hampshire, who are experienced in performing this procedure for patients will recommend it when it is the best option for a particular patient's needs.

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Wondering what life would be like free of glasses or contact lenses? Then you owe it to yourself to consider LASEK. LASEK is an alternate treatment for refractive patients who are not ideal candidates for LASIK. It's a safe and effective procedure that treats a wide range of vision problems. Patients with unusually thin corneas are one group who might be best treated with LASEK.

LASEK provides a number of very important advantages like: allowing more patients to safely enjoy the benefits of refractive surgery, the microkeratome incision step is not required, and there is less discomfort and more rapid return of vision than with PRK.

If you have questions about LASEK, please contact one of the LASEK surgeons in our directory to schedule a consultation today! Doctors such as Dr. Gailitis in Miami, Florida and Dr. Sambursky of Binghamton, New York are experts on LASEK and can help you find the procedure that's best for you.

Correctible Vision Conditions.

Clear vision is the result of light passing through a perfectly shaped eye so that it focuses clearly on the retina. Abnormal focusing conditions of the eye are called refractive errors and consist of the following:

Nearsightedness (myopia) - Nearsightedness occurs when the cornea is too curved or the eye is too long. Light passes through the eye but focuses in front of the retina, which causes distant objects to appear blurry.
Farsightedness (hyperopia) - Farsightedness occurs when the cornea is too flat or the eyeball is too short. This causes light to focus at a point beyond the retina, resulting in blurry near vision and sometimes blurry distance vision as well.
Astigmatism - Astigmatism occurs when the cornea is oval-shaped like a football. When light passes through the cornea, it focuses in more than one place relative to the retina, which causes images near or far to appear blurred and distorted.
What to Expect after LASEK

The LASEK procedure is very similar to the LASIK procedure. The procedure itself only takes a few minutes. However, the recovery after LASEK takes a bit longer. For the first 24-48 hours after the procedure a contact lens bandage must be worn to protect the cornea. Recovery to crisp sharp vision usually takes several days to several weeks. For this reason, most laser vision correction surgeons usually perform LASEK on each eye a few days to a few weeks apart, unlike LASIK that is usually performed bilaterally. In addition, patients will usually use topical eye medicaltions for a couple of months postoperatively to ensure optimal healing after the procedure. LASEK patients will experience a slightly longer healing period. Recovery times may vary, so ask your laser vision correction surgeon for more details.

LASEK Step One - The laser vision correction surgeon loosens the epithelium (the outermost layer of the cornea) by using an alcohol solution that allows the surgeon to peel back the tissue.
LASEK Step Two - The excimer laser applies a cool beam of light, which gently reshapes the cornea to correct your vision.
LASEK Step Three - After the cornea is reshaped, the epithelium is returned back to its original position. A contact lens is put in place to aid in the healing and the reduction of pain of the cornea.
This article about LASEK has been provided courtesy of DoctorDirect.

Keratoconus - Cause and Treatment




Keratoconus is a corneal dystrophy which causes astigmatism, and often leads to severe vision loss. The cause is not entirely known. The cornea becomes thin and irregular in shape, eventually bulging and becoming scarred. The word keratoconus actually translates to “cone-shaped cornea.” Advanced keratoconus requires a corneal transplant.

Cause

Keratoconus is hereditary, but many people with the gene never develop the disorder. It is believed that something, such as a hormonal change, must trigger the thinning of the cornea. Once the process has started things like wearing poorly fitted contact lenses, excessive eye rubbing, exposure to sunlight, and chronic eye irritation, can worsen the condition.

Symptoms

Symptoms of keratoconus typically appear when a person is in their late teens or early twenties. In most cases both eyes are affects, but each eye may be affected differently. Symptoms can include:

Blurred vision
Glare
Light sensitivity
Nearsightedness
Astigmatism
Frequently changing corrective lens prescription
Eye rubbing
Munson's sign – lower lid visibly distorted due to protrusion of the cornea
Treatment

In some patients the progression of keratoconus slows down or stops after 10 to 20 years. The type of treatment required depends on the severity of the condition and the associated vision loss. Initially, corrective lenses, including glasses, soft contacts, and rigid contacts can be worn to correct the astigmatism caused by keratoconus, but as the cornea becomes more distorted it can become impossible to achieve enough correction from glasses, or to create a contact lens which will fit properly. Keratoconus treatments include:

UV crosslinking – uses ultra violet rays and riboflavin (vitamin B2) to strengthen collagen in the eye, and slow down or stop the progression
Scleral Lens Prosthetic Device – acts like a bandage over the cornea
Intrastromal rings – (Intacs or Ferrara rings) plastic inserts, placed inside of the eye, which help stabilize and correct irregularities in the shape of the cornea, sometimes making it possible to wear contact lenses
Implantable lenses – avoid the problems of trying to fit traditional contact lenses and the further damage caused by poorly fitted lenses
Deep Anterior Lamellar Keratoplasty (DALK) or Automated Lamellar Therapeutic Keratectomy (ALTK) – replaces the anterior layers of the cornea with donor tissue, without the risk of rejection associated with full corneal transplant
Penetrating keratoplasty – about 20% of people with keratoconus eventually require a full corneal transplant
Hope for the Future

A full corneal transplant carries the risk of rejection and typically does not permanently improve vision. New treatments for keratoconus are constantly being researched, and more effective alternatives to corneal transplants are becoming available. The Global Keratoconus Foundation was created to help people with keratoconus by bringing the experts together and creating a support community where both patients and doctors can share their knowledge. They have made significant progress toward eliminating the need for full corneal transplants, and are now working to eliminate keratoconus as a health issue. Early treatment and less invasive treatment methods can greatly improve the outcome of keratoconus and the likelihood of retaining good vision.

For more information on keratoconus, click here to visit KCGlobal, the Global Keratoconus Foundation.

If you are experiencing the symptoms of keratoconus, talk to an experienced ophthalmologist today. Visit The Global Keratoconus Foundation to learn more about the condition and the advancements in treatment being made every day.

Keratoconus




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Keratoconus causes the cornea to become thin, weaken, and bulge. The word itself translates to “cone-shaped cornea.” Nearsightedness, astigmatism, glare, and light sensitivity are common early symptoms of the disorder. Over time the cornea can become very thin, steep, and irregular causing severe vision loss and making it impossible to wear contact lenses.

Symptoms
Symptoms normally start to appear when a person is in their late teens or early twenties, and then progress for ten to 20 years. Each eye may be affected differently. In some people the progression eventually slows down, and the condition may stabilize. Symptoms can include:

Nearsightedness
Astigmatism
Blurred vision
Glare
Light sensitivity
Frequently changing corrective lens prescription
Eye rubbing
Munson’s sign – only appears in advanced cases, lower lid is visibly distorted due to protrusion of the cornea
Hydrops
In advanced cases, a protective layer of tissue called Descemet’s membrane can rupture allowing fluid to flow into the cornea and causing sudden vision impairment. This phenomenon is called hydrops. A white spot appears on the cornea, and the entire eye may appear opaque. The effects diminish as the Descemet’s layer heals. In some patients hydrops causes corneal scarring which flattens the cornea and actually makes it easier to fit contact lenses.

Causes
The cause of keratoconus is uncertain, but heredity is thought to play a role. Recent research shows a link between a malfunction of enzymes in the eye and a chemical imbalance causing the cornea to thin. Some believe that it is a side effect of disease. What we do know is that exposure to sunlight, eye rubbing, chronic eye irritation, and wearing contact lenses which do not fit correctly can further the damage.

Treatments
Treatments and vision correction vary depending on how advanced the condition has become. Over time keratoconus caused the cornea to become very steep, thin, and irregular, meaning that as the disorder progresses the measures necessary to correct vision advance as well.

Glasses and soft contacts. Corrective lenses can improve vision during the very early stages of keratoconus, but eventually most people will need to wear rigid gas permeable contact lenses. They must be fitted correctly to prevent further damage.
Intacs. Plastic inserts, placed inside of the eye, can help stabilize the cornea. They can correct some amount of nearsightedness, and by making the shape of the cornea more regular, can mean the ability to wear contact lenses.
Corneal collagen cross-linking riboflavin. A new treatment using eye drops containing Vitamin B2 (riboflavin) and a special light, can strengthen collagen in the eye, and may stop the progression of the disorder.
Corneal Transplant. About 20 percent of patients will require a cornea transplant. In most patients corneal transplant provides good vision for at least five years.
Keratoconus involves corneal thinning and, therefore, LASIK and any other type of refractive surgery that involves removing corneal tissue are unsafe for people with the disorder. Because there is strong evidence that the condition may be hereditary and delayed diagnoses if keratoconus is fairly common, if you have a family history of the disorder you should inform your ophthalmologist and be tested before undergoing refractive surgery.

For more information on keratoconus, click here to visit KCGlobal, the Global Keratoconus Foundation.

Click here for more information on vision disorders.

If you have a family history of keratoconus and are considering LASIK, talk to your ophthalmologist about the risks and alternatives today.
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