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Cataract, Dry Eye and LASIK FAQS

Please click any of the menus items below to choose between Cataract, Dry Eye and LASIK FAQS.

People with Dry Eye may have scratchy, sandy-gritty irritation or burning in their eyes. Initially people may have symptoms when exposed to extremely dry environments such as that seen in airplane cabins or after long days driving in their car, or with contact lens wear. Sometimes there is no irritation but just occasionally redness of the eyes or intermittent tearing. A very common symptom of Dry Eye is intermittent blurring of vision.

Over time the symptoms may become worse upon awakening or in some cases worsen later in the day. Symptoms alone are usually insufficient to make a definitive diagnosis. Robbins Eye utilizes special tests to make a scientific diagnosis. These tests include Schirmer Test, tear film osmolarity, InflammaDry, meiboscan, tear break up time and Lipiview. Robbins Eye is the first Center for Excellence for Dry Eyes in the Rochester area.

Many prescribed medications can cause or worsen existing Dry Eye Syndrome. Also many OTC medications, in particular anti-histamines and anti-allergy compounds can exacerbate Dry Eye symptoms. Environmental conditions are also frequently a factor as is climate. LASIK surgery temporarily disrupts the ocular surface/lacrimal gland unit. This condition usually returns to pre-surgical status in 3-6 months.

Diseases that may be associated with Dry Eyes include Rheumatoid Arthritis, Diabetes, Asthma, Thyroid disease (lower lid does not move when blinking), Lupus, and possibly Glaucoma.

Age is a contributing factor to Dry Eye as it  affects 75% of people over age 65. Tear volume decreases as much as 60% by age 65 vs. age 18.

Hormonal changes for women can cause decreased tear production brought on by pregnancy, lactation, menstruation, and post menopause.

Dust, Pollen, and Tobacco – When tear production decreases, dust and pollen stay in the eye longer and are more likely to stimulate an allergic response. In addition, anything that makes an eye more irritated, including Dry Eye, will make an eye more sensitive to environmental irritants such as tobacco smoke.

Other – Too much coffee drinking, smoking, wearing contact lenses, air-conditioning or heat.

Dry is is actually much more common in places that are cold and dry like Rochester NY compared to say Miami FL that is typically warm and humid.  Basically, the cold dry air causes your tears to evaporate at a faster rate and this contributes to Dry Eye.

When reading or watching television, the rate that you blink is reduced and this causes the tear film to evaporate leading to dryness of the eyes. This may happen to people they are tired, or have spent long hours watching television or working in front of a computer screen.

Up until recently the “go to” standard treatment options include over-the-counter artificial tears for temporary dry eye relief, prescription therapies, and punctal plugs.  However, there is a new treatment known as LipiFlow and Robbins Eye has invested in the equipment and necessary training to offer what is an revolutionary treatment regimen for this chronic problem.

LipiFlow Thermal Pulsation technology applies controlled heat to the inner eyelid, and mild intermittent pressure releasing lipids from the blocked Meibomian glands. It does this without damage to the glands or the delicate structures of the eye. LipiFlow treats the upper and lower eyelids simultaneously. In effect it unclogs the glands and allows your eyes to produce more and better quality tears.

In addition, there are medications which can be extremely helpful in treating the underlying inflammation. Restasis was the first eye dop FDA approved to treat keratoconjunctivitis sicca and Dry Eyes. It has helped millions of dry eye sufferers around the world. Last year a new drug received FDA approval to treat the signs and symptoms of chronic Dry Eye: Xiidra. These medications are instilled twice daily and are covered by many insurance plans

Dry Eye is a disease that, over time, can decrease the eye’s ability to make and/or maintain sufficient quality and quantity of tears for a healthy tear film. It is also known by the scientific name, keratoconjunctivitis sicca, and by other terms such as dry eye syndrome or dysfunctional tear syndrome. The tear film helps protect the front surface of the eye and keep it moist and well lubricated. Severe forms of Chronic Dry Eye may lead to other consequences for your eyes, including damage to the front surface of the eye, increased risk of eye infection, and it may also affect  your vision.

Clouding of the residual back wall of the cataract or posterior capsule is common months to years after surgery. We are able to treat this condition with our YAG laser. Dr. Robbins was one of the first surgeons in New York to utilize the YAG laser to treat the condition. The laser creates a small opening in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy and usually performed in our office. It is covered by most insurances and patients may resume normal activities the same day.

Cataract surgery is a routine procedure with very little risk of side effects and a comparatively low risk of infection. Although complications are not common, risks include excessive inflammation, clouding of the cornea, swelling of the central retina (macula), retinal detachment, bleeding, and dislocation of the implant. Your doctor will discuss additional risk factors that may pertain to your eyes.

 

Cataracts can be especially hard on vision in direct sunlight, you may want to wear darkening sunglasses and a sun visor to control glare when outside. They also can adversely affect night vision. Avoid driving at night especially when it is raining and on poorly lighted roads.

There is a common misconception that cataracts need to be “ripe” before they can be removed and vision improved. In most cases the indication for surgery is the individual is becoming functionally impaired by the resultant decrease in vision. If the cataracts are impairing one’s lifestyle and optical aids will not significantly improve vision, cataract surgery becomes the best option.

With the newest technology using our Wavelight Allegretto laser, over 99% of our patients, after treatment achieve 20/40 or better vision without glasses or contacts (which is good enough to pass the driver’s license test) and over 90% have 20/20 or better vision without glasses or contacts. If you are over 45 years old and wear glasses for reading or bifocals, trifocals etc. you will most likely still require reading glasses. For many blended vision or monovision allows even these individuals to achieve excellent functional vision both far away and near.
A significant percentage of our patients see better after laser treatment without any glasses or contacts than they did prior to the treatment with the glasses or contacts.

When performed by a board-certified ophthalmic surgeon preferably with special additional training in Cornea like Dr. Robbins using state of the art equipment, LASIK treatments are extremely safe. Like any surgical procedure, the risk for complications is real. Not only is important to do everything possible to avoid complications, but the surgeon must recognize that a complication exists and what steps to take to remedy the situation.

Much of what is done to avoid complications starts long before the actual surgical procedure. At Robbins Eye we employ very sophisticated testing to determine if you are a suitable candidate for LASIK. This includes a Pentacam which maps not only the front surface of the cornea but the inner back curve as well. Dry eye testing is performed utilizing some of the latest dry eye diagnostic equipment not generally available.

This boils down to the same reason not all laptops are the same. Or not all cars are the same. All lasers that are used in the United States must be approved by the Food and Drug Administration (FDA), but they are of varying quality and offer different levels of performance and features. The Allegretto Wavelight EX500 is the most recent device to get approval for LASIK. In the FDA clinical trials it achieved better outcomes than any laser tested previously. It has also been granted the broadest range of prescription approvals by the FDA. It is the 9th laser platform that Dr. Robbins in his experience the best so far by a wide margin.

There are a few main complications that patients should be aware of. Of course, other problems are possible.  Here are a few:

1) Need for possible future LASIK procedure called an enhancement.

No laser system yields 20/20 vision or optimal results 100% of the time. To some degree this is due to variations in healing from person to person and even eye to eye in the same person. Our overall enhancement rate is very low, much less than 4% but is higher for some prescriptions. Your surgeon will advise you if you fall into one of those categories.

2) Dryness.

Increased dryness on a temporary basis is very common after Lasik. Permanently increased dryness is rare but can occur. Naturally,  dryness after LASIK treatment is more common in people who had dryness prior to the surgery, and will often last up to several months.

Robbins Eye does extensive testing for the presence of Dry Eye prior to surgery. Additional therapy above and beyond artificial tears may initiated prior to or immediately after surgery. These include but are not limited to specially formulated Omega-3 preparations, Restasis, Xiidra and Punctal plugs.

3) Halos and night vision symptoms.

Night vision issues are much less of a problem since we began using the Allegretto  Wavelight laser. This is a result of the proprietary treatment profiles and the manner in which the blend zones are managed. However, this still remains a problem with other lasers and can still infrequently occur even with the latest technology.

Everyone sees some degree of halos at night whether or not they have had LASIK or not.  You can prove this by looking at the full moon in the late evening when it is dark and you will notice that there is softness to the edge of the moon. This is call this a halo. When you view the full moon during the daylight, this softness is not present. When LASIK was in its infancy and when using older lasers, the halos were made worse in around 25% percent of patients. Although this uncommonly interfered with the ability to drive or live your life, it was annoying for some people.
After LASIK it is not unusual to experience a short-term increase in the night halos, lasting for weeks and occasionally longer. However, since switching to the Allegretto Wavelight system we rarely have patients with any significant haloing at night on a long term basis.

There have been millions of people treated with LASIK and for the most part the risk of serious complication is very low, much less than 1 percent. Some studies have even shown that LASIK procedures have less complications than wearing contact lenses.

Yes the type of laser is an enormous consideration in deciding which doctor to use. Modern laser systems are much more consistent with refined treatment technology that achieves significantly better results. The Allegretto Wavelight EX500 has a wavefront optimized treatment profile with a unique blend zone and larger effective optical zones. It also has the most extensive prescription range approved by the FDA to treat nearsightedness, farsightedness and astigmatism.

Your eye is gently held open by an instrument, so it’s virtually impossible for you to close your eye during the procedure. During the actual tissue removal with the laser (ablation) the Allegretto Wavelight system uses a sophisticated tracking system that measures the position of your eye hundreds of times per second. The laser follows your eye and is therefore always perfectly centered on target. If for some reason your eyes suddenly moves to a degree that the laser loses it lock, it will not fire a pulse. One major advantage of the latest Allegretto laser is it fires 500 times a second! So treatments that take minutes with older lasers take seconds with the EX500.

There is excellent, consistent, repeatable data going back to the late 80s and early 90s confirming excellent long term results. Dr. Robbins has been performing refractive surgery for over 20 years and participated in the FDA clinical trials for PRK. The stability of the outcome of LASIK has been proven in multiple clinical studies and is our experience at Robbins Eye.

A stable prescription is but one of the criteria we use to determine who is a suitable candidate for LASIK. In most cases your prescription stops changing in your late teens to early 20’s. We often can tell during a free consultation if your prescription is stable. Records from prior eye exams or old glass prescriptions or even old spectacles are helpful in making this determination.

The recovery time after LASIK can vary from person to person and is somewhat dependent on your prescription. Most patients see well enough the day following surgery to drive themselves to the office and return to work. Everyone is different when it comes to healing and some individuals particularly with stronger prescriptions may take considerably longer to achieve the desired outcome.

The recovery time after LASIK can vary from person to person and is somewhat dependent on your prescription. Most patients see well enough the day following surgery to drive themselves to the office and return to work. Everyone is different when it comes to healing and some individuals particularly with stronger prescriptions may take considerably longer to achieve the desired outcome.

For the vast majority of eyes, astigmatism can be successfully treated. Many years ago, when laser technology was in its infancy, astigmatism was difficult to correct. Even today most lasers currently available can only treat up to 3 units of astigmatism. The  latest generation of the Allegretto Wavelight utilized by Dr. Robbins is FDA approved to treat twice that amount. If you have been told elsewhere you are not a candidate for LASIK or your prescription is too strong the problem may be with the technology at hand and not your eyes.

Cataracts result when the natural lens inside the eye loses its transparency. It is not a film or additional layer. For most people the natural lens inside the eyes functions exquisitely for the first 4 to 5 decades of life. As the lens thickens and loses clarity spectacles can compensate for the loss of function for many years. Eventually the lens inside the eye becomes either so opaque or optically distorted that it significantly impairs vision and is labeled a cataract.

Unfortunately, there are currently no other successful treatments for cataracts other than surgery. If you feel you are not mentally ready for surgery, new glasses may provide some temporary improvement in vision.