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What is a Cataract?
A cataract occurs when the normally clear lens of the eye becomes cloudy and interferes with light passing through the eye. Cataracts are a process of aging and usually begin developing around midlife. Approximately 70% of people over the age of 60 and 90% of people over 70 will develop cataracts. The process is generally gradual, and people often do not realize what is happening until they have an eye exam. Common symptoms of cataracts may include blurry vision, glare and reduced vision in bright light, halos around light, poor night vision or fading of colors. Untreated, cataracts are a common cause of blindness.

How is a Cataract Removed?
Modern surgical techniques have made cataract removal one of the safest and most successful surgeries today. The virtually painless procedure takes about 10 minutes and is usually performed in a hospital on an outpatient basis. The eye is anesthetized using eyedrops, and a small incision (about one-eighth of an inch) is made in the white of the eye or through the outer edge of the cornea. An ultrasonic instrument is inserted and used to emulsify, or break up, the cataract and then vacuum away the damaged material. After the cataract has been removed, the surgeon inserts an intraocular lens to replace the natural lens that was removed. The day after surgery you will return for a checkup and your doctor may ask you to return later for one or more follow-up examinations and vision tests. Most patients notice an improvement in their vision during the first few days after surgery.

What is an Intraocular Lens?
An intraocular lens (IOL) is usually implanted during cataract surgery to replace the clouded natural lens that is being removed. A comprehensive eye examination prior to surgery and discussion with your doctor will determine what type, size and power of IOL is needed. The prescription lens implants are made from a flexible plastic that can be folded and inserted into the same small incision used to remove the cataract. The IOL is held in place inside the eye by tiny wires attached to the implant. Once the lens is implanted, it functions similarly to a natural lens and usually is not detectable to the patient.

There are many common childhood eye problems such as infection, injury, disorders such as amblyopia, or “Lazy Eye”, or vision problems like nearsightedness, farsightedness or astigmatism. Observing your child’s eyes and paying attention to how your child behaves is very important. Unusual behavior such as closing one eye or tilting the head to see things can be a warning sign. School-age children may complain of things looking blurry or not being able to see the chalkboard. Fortunately, most childhood eye problems can be corrected if detected early. To help protect your child’s sight, watch for warning signs and take your child to a doctor at the first sign of a problem.

Test your eyesight by performing a visual acuity test using the Interactive Visual Acuity Chart (IVAC).

Guidelines for Childhood Eye Exams
The American Academy of Pediatrics and the American Association for Pediatric Ophthalmology and Strabismus agree that all children should have their eyes examined by the pediatric or family doctor at birth and at all regular check-ups before school. At the age of 3 to 4, the exams should include vision testing using acuity charts. Urgent or more frequent eye exams should take place if you see one or more of the following warning signs:

Lack of eye fixation
A normal baby should be able to look at your face and follow your eyes as you move from side to side.

Misalignment of the eyes
As early as 2 to 3 months after birth a baby’s eyes should be aligned on interesting objects, near and far, left and right, and up and down.

Jerking eye movements
The eyes should rest steadily without jerking side to side or up and down.

White pupil
The pupil is the hole in the iris through which light enters the back of the eye and the retina. Under normal conditions, the pupil should be black.

Swelling around the eyelids
Lumps, changes in color or swelling around the eyes and lids can be caused by tumors or infections.

Excess tearing
Serious inflammations, blurry vision and nerve problems are possible reasons for excess tearing.

Drooping lid
Abnormalities of the brain or tissue around the eye may cause one or both lids to droop or retract. Some children have drooping lid at birth, which may cause vision loss as well.

Squinting or frequent blinking
Partially closed eyelids may produce temporary improvement or some types of blurry or double vision. Frequent blinking may occur with eye inflammation or allergies or with neurologic disorders.

Irregular pupil
Pupil should be round and reactive to bright light. Irregular pupil can signal an eye problem.
Children with certain medical or family risk factors should have comprehensive ophthalmic examinations, including:

Family H/O of glasses < 7 yo or Amblyopia
Family History of Hereditary Eye Disease- Retinoblastoma, Phacomatosis, retinal dystrophy/degeneration
Clinical Findings
Failed vision screening by vision screening devices or visual acuity charts
High hyperopia or myopia
Ocular Albinism
Ocular Torticollis (abnormal head posture due to an eye problem)
Neurodevelopmental Delay
Fetal alcohol syndrome, delayed visual maturation
Any opacity of the ocular media (Leukocoria)
Congenital Cataract and Glaucoma
Systemic Disease with Ocular Manifestation
Phacomatosis: NF, tuberous sclerosis, von Hippel-Lindau disease, Sturge-Weber syndrome, Incontinentia pigmenti, Ataxia-telangiectasia, Wyburn-Mason syndrome, Down syndrome, Juvenile Idiopathic Arthritis
Eyelid abnormality
Ptosis, epiblepharon, proptosis, eyelid mass
Cranial facial malformation
Crouzon syndrome, Apert syndrome
What to Expect During Your Child’s Exam

Visual Acuity Testing
Visual acuity will be checked. This is possible even in children who are not old enough to speak. For older children, picture charts, letter games and letter recognition can be used.

Eye Alignment (Muscle Balance) Testing
Various methods are used to test the alignment of the eyes and to make sure the muscles that move the eye are functioning normally. This may be done using light reflexes or alternately covering each eye to make sure that they do not move from the straight-ahead position.

Binocular Vision Testing
These tests are used to make sure that the eyes are not only aligned correctly, but that the brain is using them together as well.

Refraction Testing
Refraction is used to measure the “power” of the eye. It determines if your child is nearsighted, farsighted or has astigmatism. This can even be performed in infants when they cannot cooperate to tell us how well they are seeing. In young children, the focusing power of the eye must be eliminated to allow an accurate measurement. Therefore, drops are placed into the eye to dilate the pupil and eliminate their focus mechanism. These drops often take 30–60 minutes to work and do not wear off for 8–12 hours.

Fundus Examination
During a fundus examination, the examiner uses a special light, often worn on his or her head, to look into the back of your child’s eye. The retinal blood vessels and the optic nerve, an extension of the brain, can be seen. Because this is an area where blood vessels and portions of the brain can be seen, it is very valuable in helping to diagnose many disorders that can affect the entire body. Once the examination is complete, your child may be prescribed glasses. Treatment for other problems may also be addressed.
Common Childhood Eye Disorders

Amblyopia, also know as “lazy eye” is reduced vision in an eye that has not received adequate use during early childhood. It is estimated that 4% of children suffer from this form of visual impairment. If not treated early enough, an amblyopic eye may never develop good vision and may even become functionally blind. Amblyopia has many causes. Most often, amblyopia results from either a misalignment of a child’s eyes, such as crossed eyes, or a difference in image quality between the two eyes, meaning one eye focuses better than the other. With early diagnosis and treatment, the sight in the “lazy eye” can be restored. Glasses are commonly prescribed to improve focusing or misalignment of the eyes. Patching or covering the better-seeing eye may be required for a period of time. This forces the “lazy” eye to work harder, thereby strengthening its vision. Medication may also be used to blur the vision of the good eye in order to force the weaker one to work. Surgery may be performed on the eye muscles to straighten the eyes if nonsurgical means are unsuccessful. Eye exercises may be recommended before or after surgery as well.

Strabismus, commonly known as crossed eye, is a misalignment of the eye due to muscle imbalance. This misalignment substantially reduces depth perception. Strabismus occurs in approximately 4% of children and young adults. Strabismus has an inherited pattern and is much more common in children who have one or more parents that were affected. Treatment of strabismus may include patching of one eye or corrective lenses. However, the majority of children with strabismus will eventually require surgery to better align the eyes. Strabismus surgery commonly entails recession or resection of eye muscles to different sections of the eye to either weaken or strengthen them depending on the case. Strabismus surgery is generally successful in realigning the eyes as close to normal as possible.

Congenital Ptosis
Congenital Ptosis refers to a drooping of the eyelids that is present at birth. The drooping is due to improper development of the levator muscle, a major muscle responsible for elevating the upper eyelid. The lid may partially or fully cover the eye, and it may occur in one or both eyes. Children affected by congenital ptosis may need to tilt their head back, lift their eyelid with a finger, or raise their eyebrows to see from under their drooping lid. Congenital ptosis is treated surgically and is generally performed during a child’s preschool years.

Pediatric Cataract
The diagnosis of a congenital cataract, or a clouding of the eye’s natural lens, can be made on the first day of life by a pediatrician in the newborn nursery. Early diagnosis and referral are important. Irreversible damage will occur if a congenital cataract is not treated in the first few months of life. If the cataract is determined to be visually significant, surgery is indicated to remove the lens.

Child Eye Safety
Each year, thousands of children have eye accidents at home, at play or in the car. These eye injuries can damage a child’s sight and even cause blindness. Parents are urged to acquaint themselves with potentially dangerous situations at home and in school and to insist that their children use protective eyewear when participating in sports or other activities.

To provide the safest environment for your children:

Select games and toys that are appropriate for your child’s age and responsibility level.

Provide adequate supervision and instruction when children are handling potentially dangerous items, such as pencils, scissors and utensils.

Be aware that even common household items such as paper clips, elastic cords, wire coat hangers, rubber bands, and fishhooks can cause serious eye injury.

Keep all chemicals and sprays out of reach of small children.

Do not allow children to ignite fireworks or stand near others who are doing so. All fireworks are potentially dangerous for children of any age.

Do not allow children in the yard while a lawnmower is being operated. Stones and debris thrown from moving blades can cause severe eye injuries.

Demonstrate the use of protective eyewear to children by always wearing protective eyewear yourself while using power tools, rotary mowers or lawn trimmers.

When participating in shop or some science labs, students should wear protective goggles that meet the American National Standards Institute (ANSI) Z87 safety code.

According to Prevent Blindness America, more than 40,000 people each year are treated for eye injuries related to sports activities. For all age groups, sports-related eye injuries occur most frequently in baseball, basketball and racquet sports. Almost all sports-related eye injuries can be prevented. Whatever your game, whatever your age, you need to protect your eyes. While protective eye gear may not be the latest craze in tennis or baseball, think for a moment about what could happen if we fail to protect our eyes. We wear helmets to protect our head and pads or braces to protect our bones and joints. Extra precautions are taken to prevent concussions, broken bones, bruises and chipped teeth, so what about our eyes? What can we do to prevent the possibility of permanent vision loss, a scratched cornea or fractured eye socket? Broken bones and bruises will usually heal, but a serious eye injury can put you on the disabled list for life.

The following guidelines can help you find a pair of eye guards right for you:

If you wear prescription glasses, ask your eye doctor to fit you for prescription eye guards.

Buy eye guards at sports specialty stores or optical stores. At the sports store, ask for a sales representative who’s familiar with eye protectors to help you.

Don’t buy sports eye guards without lenses. Only “lensed” protectors are recommended for sports use. Make sure the lenses either stay in place or pop outward in the event of an accident. Lenses that pop in against your eyes can be very dangerous.

Fogging of the lenses can be a problem when you’re active. Some eye guards are available with anti-fog coating. Others have side vents for additional ventilation. Try on different types to determine which is most comfortable for you.

Check the packaging to see if the eye protector you select has been tested for sports use. Also check to see that the eye protector is made of polycarbonate material. Polycarbonate eye guards are the most impact-resistant.

Sports eye guards should be padded or cushioned along the brow and bridge of the nose. Padding will prevent the eye guards from cutting your skin.

Try on the eye protector to determine if it’s the right size. Adjust the strap and make sure it’s not too tight or too loose. If you purchased your eye guards at an optical store, an optical representative can help you adjust the eye protector for a comfortable fit.

Until you get used to wearing a pair of eye guards, it may feel strange, but stick with it! It’s a lot more comfortable than an eye injury.

What Is Diabetic Eye Disease (Diabetic Retinopathy)?
With diabetes, the body can’t use or store sugar properly. Diabetes damages the blood vessels in the eye. The damage of the blood vessels causes diabetic retinopathy. In later stages, the disease may lead to new blood vessel growth over the retina. The new blood vessels can cause scar tissue to develop, which can pull the retina away from the back of the eye. This is known as retinal detachment, and it can lead to blindness if untreated. The presence and severity of diabetic retinopathy is related to the duration of diabetes. However, severe and significant diabetic retinopathy can be present at the time of diagnosis especially with adult onset diabetes.

Signs And Symptoms Of Diabetic Retinopathy
Everyone who has diabetes is at risk for developing diabetic retinopathy. In the early or advanced stages of diabetes, symptoms may be absent or minimal. Therefore, regular diabetic screening evaluations are recommended. The symptoms of diabetic retinopathy can include floaters, blurred vision or double vision. Sometimes difficulty reading or doing close work can indicate that fluid is collecting in the macula, the most light-sensitive part of the retina. This fluid buildup is called macular edema.

Treatment Of Diabetic Retinopathy
The severity of diabetic retinopathy can be limited or prevented by close monitoring and control of blood sugars, blood pressures and blood lipids, such as cholesterol. Control of any one of these risk factors can reduce the severity of diabetic retinopathy. According to the American Academy of Ophthalmology, 95% of those with significant diabetic retinopathy can avoid substantial vision loss if they are treated in time. The possibility of early detection is why it is so important for diabetics to have a dilated eye exam at least once a year. Diabetic retinopathy can be treated with laser photocoagulation to seal off leaking blood vessels and destroy new growth. Laser photocoagulation doesn’t cause pain, because the retina does not contain nerve endings. In some patients, blood leaks into the vitreous humor and clouds vision. A procedure called a vitrectomy removes blood that has leaked into the vitreous humor. The body gradually replaces lost vitreous humor, and vision usually improves.

Cornea and External Disease
The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. Although the cornea is clear and seems to lack substance, it is actually a highly organized group of cells and proteins. Unlike most tissues in the body, the cornea contains no blood vessels to nourish or protect it against infection. Instead, the cornea receives its nourishment from the tears and aqueous humor that fills the chamber behind it. The cornea must remain transparent to refract light properly, and the presence of even the tiniest blood vessels can interfere with this process. To see well, all layers of the cornea must be free of any cloudy or opaque areas.
Because the cornea is as smooth and clear as glass but is strong and durable, it helps the eye in two ways:

It helps to shield the rest of the eye from germs, dust and other harmful matter.
The cornea acts as the eye’s outermost lens. It functions like a window that controls and focuses the entry of light into the eye. The cornea contributes between 65 and 75 percent of the eye’s total focusing power.
Conjunctivitis (Pink Eye)
Conjunctivitis describes a group of diseases that cause swelling, itching, burning and redness of the conjunctiva, the protective membrane that lines the eyelids and covers exposed areas of the sclera, or white of the eye. Conjunctivitis can spread from one person to another and affects millions of Americans at any given time. Conjunctivitis can be caused by a bacterial or viral infection, allergy, environmental irritants, a contact lens product, eye-drops, or eye ointments.
At its onset, conjunctivitis is usually painless and does not adversely affect vision. The infection will clear in most cases without requiring medical care. But for some forms of conjunctivitis, treatment will be needed. If treatment is delayed, the infection may worsen and cause corneal inflammation and a loss of vision.

Dry Eye
The continuous production and drainage of tears is important to the eye’s health. Tears keep the eye moist, help wounds heal, and protect against eye infection. In people with dry eye, the eye produces fewer or less quality tears and is unable to keep its surface lubricated and comfortable. The main symptom of dry eye is usually a scratchy or sandy feeling as if something is in the eye. Other symptoms may include stinging or burning of the eye; episodes of excess tearing that follow periods of very dry sensation; a stringy discharge from the eye; and redness of the eye.
Dry eye can occur in climates with dry air, as well as with the use of some drugs, including antihistamines, nasal decongestants, tranquilizers, and anti-depressant drugs. People with dry eye should let their health care providers know all the medications they are taking, since some of them may intensify dry eye symptoms. Artificial tears, which lubricate the eye, are the principal treatment for dry eye. They are available over-the-counter as eye-drops. Sterile ointments are sometimes used at night to help prevent the eye from drying. Using humidifiers, wearing wrap-around glasses when outside, and avoiding outside windy and dry conditions may bring relief. For people with severe cases of dry eye, temporary or permanent closure of the tear drain may be helpful.

Corneal Injuries
The cornea copes very well with minor injuries or abrasions. If the highly sensitive cornea is scratched, healthy cells slide over quickly and patch the injury before infection occurs and vision is affected. If the scratch penetrates the cornea more deeply, however, the healing process will take longer, at times resulting in greater pain, blurred vision, tearing, redness, and extreme sensitivity to light. These symptoms require professional treatment. Deeper scratches can also cause corneal scarring, resulting in a haze on the cornea that can greatly impair vision. In this case, a corneal transplant may be needed.

Keratoconus, a progressive thinning of the cornea, is the most common corneal dystrophy in the U.S., affecting one in every 2,000 Americans. It is more prevalent in teenagers and adults in their 20s. Keratoconus arises when the middle of the cornea thins and gradually bulges outward, forming a rounded cone shape. This abnormal curvature changes the cornea’s refractive power, producing moderate to severe distortion (astigmatism) and blurriness (nearsightedness) of vision.
Keratoconus usually affects both eyes. At first, vision can be corrected with glasses. But as the astigmatism worsens, a specially fitted contact lens must be used to reduce the distortion and provide better vision. Although finding a comfortable contact lens can be an extremely frustrating and difficult process, it is crucial because a poorly fitting lens could further damage the cornea and make wearing a contact lens intolerable.
In most cases, the cornea will stabilize after a few years without ever causing severe vision problems. But in about 10 to 20 percent of cases, the cornea will eventually become too scarred or will not tolerate a contact lens. If either of these problems occur, a corneal transplant may be needed. This operation is successful in more than 90 percent of those with advanced keratoconus.

Corneal Transplant
A corneal transplant involves replacing a diseased or scarred cornea with a new one. In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea, usually donated through an eye bank. A trephine is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine thread. The thread stays in for months or even years until the eye heals properly. Following surgery, eye-drops to help promote healing will be needed for several months.
Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success of this operation have risen dramatically because of technological advances, such as less irritating sutures, or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many, who a generation ago would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.

What is Glaucoma?
Glaucoma is a condition that results in slow progressive damage to the optic nerve, which sends information from the eye to the brain. Damage to the optic nerve leads to a slow loss of vision. As a result, glaucoma is often referred to as The Silent Thief of Sight. Rick factors for glaucoma include elevated eye pressure, increased age, African-American heritage, and previous ocular injury. The most important and most treatable risk factor for glaucoma is elevated eye pressure. Inside the eye, there is a constant production of fluid that normally flows out of the eye through a very small drain. In certain individuals, this drain can become blocked for various reasons. The result is an increase in eye pressure, therefore increasing your risk of glaucoma. Glaucoma affects an estimated 3 million Americans and is the second-leading cause of blindness in the United States.

Types of Glaucoma

Open-Angle Glaucoma
Open-Angle Glaucoma: Open-angle glaucoma occurs slowly as the drainage area in the eye becomes clogged. Pressure builds up when the fluid inside the eye is unable to drain. Side (peripheral) vision is damaged gradually. Open-angle glaucoma is the most common kind of glaucoma.

Closed-Angle Glaucoma
Closed-Angle Glaucoma: With closed-angle glaucoma, eye pressure builds up rapidly when the drainage area of the eye suddenly becomes blocked. Blurry vision, rainbow halos around lights, headaches or severe pain may occur with closed-angle glaucoma. This type of glaucoma is less common than open-angle and may cause blindness if it is not treated immediately.

Questions and Answers

Q. What is the best way to detect glaucoma?

Careful examination of the optic nerve coupled with visual field testing and intraocular pressure measurement provides the necessary information to determine if damage from glaucoma is present.

Q. If I am having no visual or ocular problems, can I be certain that I do not have glaucoma?

No. In fact, people with significant levels of damage may not have visual symptoms until most of the optic nerve function is lost. This is because the disease process is generally very slow, giving glaucoma the nickname “The Silent Thief of Sight”. In most cases, damage occurs to side (peripheral) vision first, and one eye may have significant field loss, but the other does not, so with both eyes open a person may not realize the extent of the damage.

Q. What can I do to reduce my risk of further damage?

The two most important things you can do if you are diagnosed with glaucoma are to keep follow-up appointments and faithfully use ocular medications as prescribed. Careful monitoring and consistent treatment can often stabilize this disease process.

What is Macular Degeneration?
Age-related Macular degeneration (AMD) is a disease associated with aging that gradually destroys sharp, central vision. The disease attacks the macula, the central area of the retina that allows a person to see fine detail. Individuals can lose all but the outermost peripheral vision, leaving dim images or black holes at the center of vision. Central vision is needed is needed for seeing objects clearly and for common daily tasks such as reading, driving, identifying faces and watching television. AMD is a leading cause of vision loss and legal blindness in adults over 60 in the United States.

Two Types of Macular Degeneration
Macular degeneration is diagnosed as either dry or wet. Dry AMD is more common than wet AMD, with about 90% of people having the dry type and 10% of people having the wet type. However, even though the wet type is less common, 90% of severe vision loss comes from the wet type and only 10% from the dry type.

Dry AMD occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision in the affected eye. It is diagnosed when yellow deposits known as drusen accumulate in the macula. Dry AMD causes gradual central vision loss, but the loss usually is not as severe as can be found with the wet type.

Wet AMD occurs when abnormal blood vessels behind the retina start to grow under the macula. These new blood vessels tend to be very fragile and often leak blood and fluid. This blood and fluid raises the macula from its normal place at the back of the eye, causing scarring and permanent damage to light-sensitive retinal cells, which creates blind or blurry spots in the central vision.

Cause of AMD
The cause of AMD is not completely known. However, the greatest risk factor is age. The risk of having AMD increases with age, from 10% at age 50 to about 30% at age 75. Other factors that increase the risk of developing AMD include family history of AMD, smoking, diet, weight and race. Caucasians are much more likely to lose vision from AMD than other races (*NIH). Lifestyle practices like not smoking, eating a healthy diet high in green leafy vegetables and fish, exercising and maintaining normal weight and blood pressure may play a role in reducing the risk of developing AMD.

Especially with the dry form, symptoms may develop gradually. Also if only one eye is affected, a person may not notice changes in vision until the disease gets moderately worse because the unaffected eye helps to compensate for changes in vision. Having an annual eye exam is very important for detecting AMD and other ocular disorders early in their progression.
Symptoms of AMD may include blurred vision, a dark area or “blind spot”, or a distorted appearance of straight lines or other objects. It is important for people with AMD to monitor their vision closely and to call their eye doctor if there is a change in vision. One way to monitor vision or detect a problem is with an Amsler grid. The Amsler grid, which looks similar to a section of graph paper, is a diagnostic tool that aids in the detection of visual disturbances caused by changes in the retina. The Amsler grid is a very sensitive test that can reveal clinical changes before other visual symptoms develop. With new and reliable treatments for wet AMD, this tool is important for the early detection of wet AMD.
Call 1-800-237-5393 or e-mail info@wolfeclinic.com to receive a free Amsler grid.


The National Eye Institute’s Age-Related Eye Disease Study (AREDS) found that taking a specific high-dose formulation of antioxidants and zinc can reduce the risk of progression of dry AMD in some patients. The AREDS formulation is not a cure for AMD. It will not restore vision already lost from the disease. However, it may delay the onset of advancedAMD. It may also help people who are at high risk for developing advanced AMD keep their vision.

Wet AMD can be treated with laser therapy, photodynamic therapy, and injections into the eye. Some patients receive one of these treatments and some patients receive a combination of these treatments. None of these treatments is a cure for wet AMD, but they may halt the progression of the disease and in some cases allow for some gain in visual acuity.

Laser Therapy
This procedure uses a high energy beam of light to seal or destroy the abnormal blood vessels to prevent leaking and further loss of vision. However, laser treatment may also destroy some surrounding healthy tissue and some vision. Therefore, only a small percentage of people with wet AMD are treated with laser surgery- mainly those whose leaky blood vessels have developed away from the central part of the macula. The risk of new blood vessels developing after laser treatment is high and repeated treatments may be necessary.

Photodynamic Therapy
This procedure uses a combination of light and drug therapy to destroy leaking blood vessels. First a drug called Verteporfin is injected into a patients arm. It travels throughout the body, including to the eye, where it “sticks” to the surface of new leaky blood vessels. Next, a light is shone into the eye for about 90 seconds. The light activates the drug which destroys the new blood vessels, leading to a slower rate of visual decline. Unlike laser surgery, the drug does not destroy surrounding healthy tissue. This therapy slows the rate of vision loss, but does not stop vision loss altogether or restore vision in eyes already damaged by AMD. Treatment results are often temporary and may need to be repeated.

Anti-VEGF Therapy (Intravitreal Injections)
The treatment of AMD has evolved in the last 5 or so years from limiting the degree of vision loss to maintaining and even improving existing vision in some cases. This is due in no small part to Anti-VEGF (Vascular Endothelial Growth Factor) therapy. Anti-VEGF therapy works by blocking the action of VEGF, the molecule that promotes the growth of abnormal blood vessels under the retina. These drugs are injected directly inside the eye to provide maximum concentration in the area where they are needed. The eye is numbed before each injection. There may be slight discomfort and soreness on the day of the injection, but not pain. Multiple injections will be given as often as monthly, with the goal of achieving up to 3 to 6 months between injections. These drugs maintain vision in up to 90% of all patients treated. Vision may improve in up to 1/3 of treated patients.

Oculoplastics deals with disease and surgery of the structures around the eye. This may include the eyelids, the eyebrows, the lacrimal or tear system and the tissues behind the eye, known as the orbit. These structures are critical for vision. Injuries, congenital defects, aging changes and tumors affecting the eyelids as well as the tissues and bones surrounding the eyes can cause pain, eye damage, vision loss and disfigurement.

The position of the eyelid is vital to the health of the eye. Eyelid malposition can occur with aging or certain disease. There are many types of eyelid malpositions including an outward turning or ectropion, an inward turning or entropion and droopiness or ptosis. Oculoplastic surgeons can reconstruct eyelids, correct eyelid-position abnormalities, remove growths and rebuild these critical structures surrounding the eye. Other conditions treated by oculoplastic surgeons include orbital fractures and trauma, orbital tumors and cancer, lacerations and removal of the eye with subsequent reconstruction of the socket.

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