Frequently Asked Questions

Q1: What is the difference between an Optometrist, Therapeutic Optometrist, and Optometric Glaucoma Specialist?

An Optometrist is a health care practitioner trained to diagnose signs of ocular, neurological and systemic health problems and treat vision disorders. (License number designation: 4986)

A Therapeutic Optometrist may treat eye diseases and injuries, prescribe medicine and perform other procedures such as eye foreign body removal. (License number designation: 4986T)

An Optometric Glaucoma Specialist is a therapeutic optometrist who is also licensed to treat glaucoma (in a co-management process with an ophthalmologist) and may also prescribe a limited number of oral drugs. The optometrist, therapeutic optometrist, and optometric glaucoma specialist may prescribe glasses and contact lenses. The optometric glaucoma specialist has the broadest scope of practice among aforementioned optometrists. (License number designation: 4986TG) Dr.HLIS's license number is 4986TG.

Q2: WHAT IS A CATARACT?

A cataract is clouding of a normally clear, natural crystalline lens of an eye. This clouding is usually due to an aging process but can also be caused by trauma, heredity, diabetes, and even some medications. Whatever the cause, cataracts typically result in blurred or fuzzy vision and sensitivity to light.

One way to treat a cataract is to remove the cloudy lens and replace it with a new, clear artificial lens. Dr. HLIS can determine whether or not your cataract is ready to be removed. If so, he will refer you to a cataract surgeon who will remove your cataract by a process called phacoemulsification, the safest most advanced method of cataract removal. In most cases no sutures are required.

Once the cataract is removed, an intraocular lens is gently placed in the eye, providing you with functional vision.

Initially after cataract surgery your vision may be cloudy for a few days depending on the density of your cataract. Reading glasses are usually needed following cataract surgery.

Q3: WHAT IS A YAG LASER CAPSULOTOMY?

One of the recent advances in ophthalmology has been the use of a YAG laser to open the posterior lens capsule. This capsule is a thin protective membrane left in the eye following cataract surgery. If it becomes cloudy it is safely opened by the YAG laser.

Usually, an increased glare with bright lights or a gradual decrease in vision are the first signs of posterior capsular haze.

The posterior capsulotomy is a simple, painless procedure performed in a cataract surgeon’s office. A laser beam is used to create an opening in the center of the cloudy capsule. There is no pain or chance of infection since no incision is required.

After the procedure is completed, there are no restrictions on activities. The majority of patients enjoy improved vision almost immediately.

Q4: WHAT IS MACULAR DEGENERATION

Macular degeneration is the leading cause of impaired reading or detailed vision. Macular degeneration is most commonly a natural result of the aging process. With time, retinal tissues break down and become thin. This deterioration causes a loss of function of the macula, the central portion of the vision. Side vision is not affected.

Approximately 10% of patients with macular degeneration also have leakage of tiny blood vessels which are then unable to nourish the retina. Growth of new, abnormal blood vessels in scar tissue that forms from the leaking blood vessels is also common. Blood and leaking fluid destroy the macula, causing vision to become distorted and blurred. The formation of dense scar tissue blocks out central vision to a severe degree.

SUBFOVEAL CHOROIDAL NEOVASCULAR MEMBRANE w/out DETACHMENT

Q5: WHAT IS GLAUCOMA?

Glaucoma affects nearly 2 percent of the American population, representing more than two million persons and is the leading cause of blindness in the United States.

Typically, glaucoma is an insidious disease, which destroys vision slowly and relentlessly over months to years. Fundamentally, glaucoma is characterized by fluid pressure within the eye, which is too high. This pressure “pinches” and damages both the optic nerve and the blood vessels which nourish the retina. If untreated, the result is usually a slow loss of peripheral, or side vision, and eventual blindness. Fortunately, with modern treatment techniques most vision loss from glaucoma can be prevented.

Q6: HOW IS GLAUCOMA DETECTED?

In a simple, painless test, Dr.HLIS will measure the fluid pressure or “firmness” of the eyeball and evaluate the retina and optic nerve. If this intraocular pressure is unusually high or if the optic nerve proves abnormal upon examination, Dr.HLIS will probably suggest that you schedule a “visual field” test to determine if any peripheral or side vision has been lost. Periodically, Dr. HLIS will have photographs taken to assess the optic nerve condition.

Q7: HOW IS GLAUCOMA TREATED?

Early detection is crucial to the successful treatment of glaucoma. It is one reason adults past the age of 35 should visit an eye doctor every one to two years. If glaucoma is detected, it can be treated using medication, laser or filter surgery. With appropriate and timely therapy the potential for further damage to the optic nerve and resulting loss of vision is significantly reduced. The first line of therapy for most patients with glaucoma includes eye drops. Modern pharmaceutical research has provided your eye care provider with a spectrum of eye medications designed specifically to reduce eye pressure with a minimum of side effects.

A new type of glaucoma surgery, Selective Laser Treatment (SLT), approved by the FDA in March 2001 holds great promise for the treatment of glaucoma. SLT is an advanced type of laser treatment that selectively stimulates specific pigmented cells to activate increased fluid drainage and reduce your intraocular pressure.

The application of laser technology to the treatment of glaucoma has nearly revolutionized a surgeon's approach to this serious eye disease. In some instances it eliminates your dependency on eye medications. Laser surgery does not cure glaucoma, but it offers a very effective method of aiding in it's control.

Q8: WHAT IS DIABETES AND HOW DOES IT AFFECT THE RETINA?

Diabetes is a disease that occurs when the pancreas does not secrete enough insulin or the body is unable to process it properly. Insulin is the hormone that regulates the level of sugar (glucose) in the blood. Diabetes can affect children and adults.

How does diabetes affect the retina?

Patients with diabetes are more likely to develop eye problems such as cataracts and glaucoma, but the disease’s affect on the retina is the main threat to vision. Most patients develop diabetic changes in the retina after approximately 5-20 years. The effect of diabetes on the eye is called diabetic retinopathy.

Over time, diabetes affects the circulatory system of the retina. The earliest phase of the disease is known as background diabetic retinopathy. In this phase, the arteries in the retina become weakened and leak, forming small, dot-like hemorrhages. These leaking vessels often lead to swelling or edema in the retina and decreased vision.

The next stage is known as proliferative diabetic retinopathy. In this stage, circulation problems cause areas of the retina to become oxygen-deprived or ischemic. New, fragile, vessels develop as the circulatory system attempts to maintain adequate oxygen levels within the retina. This is called neovascularization. Unfortunately, these delicate vessels hemorrhage easily. Blood may leak into the retina and vitreous, causing spots or floaters, along with decreased vision.

In the later phases of the disease, continued abnormal vessel growth and scar tissue may cause serious problems such as retinal detachment and glaucoma.

Signs and Symptoms

The affect of diabetic retinopathy on vision varies widely, depending on the stage of the disease. Some common symptoms of diabetic retinopathy are listed below, however, diabetes may cause other eye symptoms.

Blurred vision (this is often linked to blood sugar levels
Floaters and flashes
Sudden loss of vision

Detection and Diagnosis

Diabetic patients require routine eye examinations so related eye problems can be detected and treated as early as possible. Most diabetic patients are frequently examined by an internist or endocrinologist who in turn work closely with an Optometric Glaucoma Specialist or Ophthalmologist.

The diagnosis of diabetic retinopathy is made following a detailed examination of the retina with a binocular indirect ophthalmoscope. Most patients with severe diabetic retinopathy are referred to vitreo-retinal surgeons who specialize in treating this disease.

Treatment

Diabetic retinopathy is treated in many ways depending on the stage of the disease and the specific problem that requires attention. The retinal surgeon relies on several tests to monitor the progression of the disease and to make decisions for the appropriate treatment. These include: fluorescein angiography, retinal photography, and ultrasound imaging of the eye.

The abnormal growth of tiny blood vessels and the associated complication of bleeding is one of the most common problems treated by vitreo-retinal surgeons. Laser surgery called pan retinal photocoagulation (PRP) is usually the treatment of choice for this problem.

With PRP, the surgeon uses laser to destroy oxygen-deprived retinal tissue outside of the patient’s central vision. While this creates blind spots in the peripheral vision, PRP prevents the continued growth of the fragile vessels and seals the leaking ones. The goal of the treatment is to arrest the progression of the disease.

Vitrectomy is another surgery commonly needed for diabetic patients who suffer a vitreous hemorrhage (bleeding in the gel-like substance that fills the center of the eye). During a vitrectomy, the retina surgeon carefully removes blood and vitreous from the eye, and replaces it with clear salt solution (saline). At the same time, the surgeon may also gently cut strands of vitreous attached to the retina that create traction and could lead to retinal detachment or tears.

Patients with diabetes are at greater risk of developing retinal tears and detachment. Tears are often sealed with laser surgery. Retinal detachment requires surgical treatment to reattach the retina to the back of the eye. The prognosis for visual recovery is dependent on the severity of the detachment.

Prevention

Researchers have found that diabetic patients who are able to maintain appropriate blood sugar levels have fewer eye problems than those with poor control. Diet and exercise play important roles in the overall health of those with diabetes.

Diabetics can also greatly reduce the possibilities of eye complications by scheduling routine examinations with an Optometric Glaucoma Specialist or Ophthalmologist. Many problems can be treated with much greater success when caught early.

Diabetic Retinopathy is one of the leading causes of blindness today. Dr. Hlis, has over 13 years experience and knowledge in analysis and proper management of this destructive, vision threatening disease.

Q9: WHAT IS LASIK?

Most people with vision correction issues are wanting to know more about LASIK and whether it is right for them. Here is a brief description of the procedure;

A flap is surgically cut in the cornea and gently folded back. An Excimer Laser is used to reshape the cornea into a flatter shape (this is much like a contact lens corrects vision by forming a new shape on the cornea). The flap is then put back in place, acting like a natural bandage. The healing process is quick and discomfort level is quite low.

People will often say that they did not feel anything, and could see well the very first day. Most people have improved vision in 24-48 hours. but it must be noted that each person will heal at a different rate. Vision, although greatly improved immediately after surgery, often continues to improve for some weeks, even months.

LASIK is not for everyone. People's eyes are different so even though you may have had a friend who has had LASIK, it may not be the best course of treatment for you. If you are interested in laser vision correction, Dr. HLIS will be happy to guide you in selecting the right surgeon, procedure and laser which is appropriate for you.

Q10: WHAT IS POST-OPERATIVE CARE?

Dr. HLIS provides post-operative services for cataract and LASIK patients. These professional services are available on a co-management basis in conjunction with selected eye surgeons. Additionally, Dr. HLIS has working arrangements with other specialized eye care surgeons to manage retinal detachments, retinal tears and hemorrhages. Dr. HLIS provides these services under a co-management program with retinal surgeons. Each patient may benefit from cooperative and combined efforts of doctors working together on his/her behalf.

COMMERCE SQUARE OPTICAL provides this on-line information for educational and communication purposes only and it should not be construed as personal medical advice. Information published on this website is not intended to replace, supplant, or augment a consultation with an eye care professional regarding the viewer/user's own medical care. COMMERCE SQUARE OPTICAL disclaims any and all liability for injury or other damages that could result from use of the information obtained from this site.

PHOTOS

NUCLEAR SCLEROTIC CATARACT

NORMAL LENS

CLOUDED CAPSULE

OPEN CAPSULE VIA YAG CAPSULOTOMY

GLAUCOMATOUS DISC

DRANCE HEMORRHAGE