Medical & SurgicalCare

CATARACT

A cataract is a clouding of the normally clear lens inside the eye.

The most common type of cataract is related to aging of the eye. Other causes include:

• Family history
• Medical problems, such as diabetes
• Trauma
• Medications, especially steriods
• Long-term, unprotected exposure to sunlight
• Previous eye surgery 

In a normal eye, light focuses precisely on the retina.

In an eye with a cataract, light scatters throughout the eye instead of focusing precisely on the retina.

Depending on the amount and pattern of the cloudiness of the lens, the symptoms of a cataract can vary. The blurred vision caused by a cataract can be compared to looking through a window that is yellowed or dirty.

Foggy Vision

Smudgy Vision

Other symptoms include:

• Glare, or light sensitivity
• Poor night vision
• Double vision in one eye
• Needing more light to read
• Fading colors

If symptoms of a cataract are not bothersome, there may be no need for treatment. However, most cataracts eventually progress to the point of needing treatment. Surgery is the only treatment for cataracts. Over 1.4 million people have cataract surgery each year in the United States , and more than 95% of those surgeries are performed with no complications.

In most cases, Dr. O'Rourke performs cataract surgery with only topical eye drops, and IV sedation. It is done in an ambulatory surgery center, and the procedure usually takes approximately 15-20 minutes.

The entire procedure is done under a microscope through a micro-incision only 3 millimeters in length. An ultrasound tip is placed into the cataract to break it up and aspirate it. This technique is called phacoemulsification , and is the state of the art procedure for cataract surgery.

The natural lens is then replaced with an artifical lens implant, which is put through the micro-incision and unfolds inside the eye.

IOL

Once a cataract is removed, it does not recur. However, in many people who have cataract surgery, the capsule that supports the artificial lens may eventually become cloudy. If this occurs, the symptoms of the cataract may return. This can be treated easily with a YAG laser treatment. This a very simple, low-risk procedure which takes minutes to perform with no need for anesthesia or post-operative restrictions. The laser is focused directly onto the capsule behind the lens implant to restore vision.

Cataracts are the most common cause of blindness in the world outside the United States . In this country we are fortunate to have excellent treatment for cataracts to prevent blindness. If you have symptoms of a cataract, visit the Northwest Eye Center . After a thorough cataract evaluation, Dr. O'Rourke will determine if a cataract procedure may help to restore your vision. With over 15 years of experience, Dr. O'Rourke has the knowledge and expertise you can depend on.

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GLAUCOMA

Glaucoma is a condition in which the pressure in the eye becomes too high and causes damage to the optic nerve. There is an internal flow of fluid in the eye, that consists of inflow and outflow mechanisms. The cause of glaucoma is unclear, but it is thought to be a result of a decrease in the outflow mechanism, which results in a rise in pressure.

In the early stages of open angle glaucoma, which is the most common type of glaucoma, there are no symptoms. Early optic nerve damage causes very subtle changes in the peripheral field of vision, which are not noticeable. However, if the glaucoma goes untreated, the visual field defects become larger until eventually, when it effects the vision, it is too late to treat and the damage is done. End-stage glaucoma results in tunnel vision, and at this stage is not treatable.

Glaucoma is a leading cause of blindness in the United States , and effects approximately 3% of the general population. But loss of sight from glaucoma is often preventable if you get treatment early enough. Routine glaucoma checks are crucial in the detection and prevention of vision loss.

At the Northwest Eye Center we use applanation tonometry to check intraocular pressure, which is the most accurate method. Dr. O'Rourke also performs a full dilated eye exam to observe the optic nerve and look for suspicious glaucomatous changes. If necessary, a computerized automated peripheral field of vision exam may be performed to detect early visual field defects.

If glaucoma is detected it can usually be treated by eye drops, once or twice daily. There are a multitude of prescription eye drops available for the treatment of glaucoma.

Laser treatment is also available in the treatment of glaucoma for the patient who does not want to use eye drops or whose glaucoma is not responding to eye drops. At the Northwest Eye Center we offer leading edge glaucoma laser surgery, which is Selective Laser Trabeculoplasty or SLT. This procedure directs laser light to the angle of the eye where the outflow mechanism is located in an effort to increase the outflow of fluid, thereby decreasing the pressure.

SLT is effective in at least 85% of cases, and is a simple, low risk procedure that only takes minutes to perform. This is a painless procedure with no post-operative restrictions. This new technology is safer than previous forms of laser surgery used for glaucoma, and can be repeated if necessary.

Narrow angle glaucoma is a much less common form of glaucoma that may lead to angle closure glaucoma. In this condition, the eye pressure builds up rapidly, and the eye becomes red and painful, with decreased vision.

This is a medical emergency and without treatment within hours, blindness may occur.

On a routine eye exam, Dr. O'Rourke may be able to detect if you have a narrow angle and are at risk for a closed angle attack. If so, a preventive laser treatment, called a peripheral iridotomy may prevent a closed angle, and loss of vision.

Vision loss from glaucoma is in most cases preventable with appropriate treatment. Let the Northwest Eye Center and Dr O'Rourke evaluate your eyes to see if you are at risk for developing this treatable condition.

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DIABETES

Diabetes may effect the eyes in several ways. If blood sugar levels fluctuate, transient fluctuation of the vision may occur. This condition is usually remedied with blood sugar control. Diabetics are also more at risk for cataracts, glaucoma, and diabetic retinopathy.

Diabetic retinopathy is a condition in which the blood vessels in the back of the eye, in the retina, are damaged by the diabetes. The blood vessels then leak fluid and blood into the retina causing a decrease in vision.

In extreme cases, the damaged vessels may bleed into the center of the eye causing a vitreous hemorrhage.

Strict control of blood sugar and blood pressure can help prevent diabetic retinopathy. Diabetics should have a complete eye examination, including dilation of the eyes at least once a year to check for cataracts, glaucoma, and diabetic retinopathy.

For diabetics at risk, blindness can be prevented if the retinopathy is diagnosed early and treated appropriately with laser surgery.

Dr. O'Rourke and the staff at the Northwest Eye Center may detect the early stages of diabetic retinopathy before you have symptoms, and can tell you if you may benefit from laser treatment. Early detection and routine eye exams are the key to the prevention of blindness.

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DRY EYES

Dry eyes is a condition that is very common in Colorado due to our dry climate and intense ultraviolet light exposure. As we grow older, our eyes simply produce fewer lubricating tears. Both men and women may be affected by dry eyes, although women are more prone after menopause and during pregnancy. Contact lenses can contribute to dry eyes because they cause an increase in tear evaporation. Common medications such as decongestants, antihistamines, diuretics, and anti-depressants can also cause dry eye.

Symptoms of dry eyes include:

• Burning and stinging
• Gritty feeling
• Itching
• Sensitivity to light
• Mucous secretions in the eye
• Decreased vision

Tearing can be a sign of dry eye as the eyes attempt to compensate for the dryness.

Severe dry eyes can result in corneal inflammation which is diagnosed with a fluorescein dye :

The first line of treatment for dry eyes is non-prescription artificial tears.

If one needs to use artificial tears more than twice daily to stay comfortable, the second line of treatment is punctual plugs . The tears drain from the eye through openings in the upper and lower lids called the puncti . When a very tiny silicone plug is put into the “punctum”, the natural tears and artificial tears stay in the eye longer. This can help with the symptoms of dry eyes and increase contact lens tolerance. Dr. O'Rourke can insert the punctal plugs during an office visit, and the procedure is usually covered by medical insurance.

If symptoms are still present after the punctal plugs, a prescription drop, Restasis, may be advised, which may increase the eye's natural tear production.

Dr. O'Rourke is participating in a nation wide FDA investigative study evaluating the effect of a new drug for dry eyes called Rebamimide. The Northwest Eye Center is one of only 2 sites investigating this drug in the state of Colorado . If you have severe dry eyes, and have not found relief with the treatments discussed above, you may be a candidate for this study.

Don't suffer with the symptoms of dry eyes. At the Northwest Eye Center we can help you find what works for you.

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MACULAR DEGENERATION

Macular Degeneration is an age related condition associated with damage to the macula . The macula is the area of the retina that is responsible for central vision. Central vision is lost when the macula doesn't function properly. Macular degeneration only affects central vision and not peripheral vision. For example, you might be able to see the outline of a clock but not be able to tell what time it is.

There are two types of macular degeneration: “dry” and “wet”, the most common being the “dry”, and this results in a mild to moderate, and slow vision loss.

About 10% of patients diagnosed will convert “dry” to the “wet” form. This occurs when leakage of fluid or blood occurs under the macula . This may be associated with a more rapid and severe loss of vision.

Studies have suggested that the anti-oxidant vitamins, A, C, and E, and also zinc and lutein, may slow the progression of macular degeneration. Also protecting the eyes from ultraviolet light exposure may be preventive as well. Avoidance of cigarette smoking has been shown to decrease the risk of macular degeneration.

Other than these preventive measures, there really is no treatm ent for “dry” macular degeneration.

However, if “wet” macular degeneration develops there are treatments available, including laser, photodynamic therapy, and medications. The sooner the treatment is given, the better the prognosis.

There are many exciting and promising new therapies under investigation at this time, and hopefully in the future we will have more effective treatments for macular degeneration.

At the Northwest Eye Center , Dr. O'Rourke can detect macular degeneration. She can determine if you are a candidate for treatment. As always, early detection is the key to a better prognosis.

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