• EYE EXAMS

    When Should You Have an Eye Exam?

    The American Academy of Ophthalmology recommends that you get a baseline eye examination at age 40, the time when early signs of disease or changes in vision may occur. Much like a screening for diabetes or certain cancers, a baseline eye exam at 40 is a reminder to adults as they age to be aware of their eye health. A baseline screening can help identify signs of eye disease at an early stage when many treatments can have the greatest impact on preserving vision.
    Some people shouldn't wait until they are 40 to have a comprehensive eye exam. If you have an eye disease or if you have a risk factor for developing one, such as diabetes, high blood pressure or a family history of eye disease, you should see an ophthalmologist (Eye M.D.) even if you are younger than 40.
    Upon examining your eyes, your Eye M.D. can tell you how often you should undergo an eye exam.  As you age, it's especially important that you have your eyes checked regularly because your risk for eye disease increases. If you are 65 or older, make sure you have your eyes checked every year or two for signs of age-related eye diseases such as cataracts, age-related macular degeneration and glaucoma.

    Source: American Academy of Ophthalmology,
    www.geteyesmart.com

    Preparing for Your Visit

    Please bring the following Items to your appointment with Ophthalmology Partners of Annapolis:

    • Bring photo ID
    • Primary Care Referral
    • Referring physician’s name, address, phone, fax
    • Health Insurance card & copayment
    • List of current medications
    • List of questions and concerns
    • Patients under 18 years old must be accompanied by a parent or guardian
    • Complete patient forms (found here)
    • Registration
    • Financial Policy Statement
    • Notice of Privacy Practices
    • Medical Records release
    • Authorization to release medical records
    • Request to amend records
    • Medical History
  • CONTACT LENSES

    Contact lenses are thin, clear disks of plastic that float on the surface of the eye. They correct vision like eyeglasses do and are safe when used with care. Contact lenses are used to correct the same conditions that eyeglasses do: myopia (nearsightedness), hyperopia (farsightedness), astigmatism (blurred vision due to the shape of the cornea) and presbyopia (inability to see close up).

    Millions of people around the world wear contact lenses. Depending on your lifestyle, your motivation and the health of your eyes, contact lenses may provide a safe and effective alternative to eyeglasses when used with proper care and maintenance.

    There are two general types of contact lenses: hard and soft. The hard lenses most commonly used today are rigid, gas-permeable lenses (RGP for short). They are made of plastics and other materials such as silicone or fluoropolymers. Hard lenses hold their shape, yet allow the free flow of oxygen through the lenses to the cornea. RGP lenses may be the best choice when the cornea has enough astigmatism (is shaped like an egg instead of an orange) that a soft lens will not provide sharp vision. They may also be preferable when a person has allergies or tends to form protein deposits on his or her contacts.


    Soft lenses are the choice of most contact lens wearers. These lenses are comfortable and come in many versions, depending on how you want to wear them.

    Daily-wear lenses are the least expensive, are removed nightly and are replaced on an individualized schedule. They should not be used as an extended-wear lens.

    Extended-wear lenses are worn overnight but are removed at least weekly for thorough cleaning and disinfection. They are being recommended less frequently, since there is a greater risk of corneal infection with any overnight wear of contact lenses.

    Disposable-wear lenses
    are more expensive, but convenient. They are removed nightly and replaced on a daily, weekly or monthly basis. Disposable lenses are sometimes recommended for people with allergies and for those who tend to form deposits on their lenses.

    Cosmetic or decorative contact lenses
    are colored contacts that change the appearance of your eye color, and in the case of circle lenses also make your iris appear bigger. Decorative lenses are available by prescription and should only be worn after an eye exam and fitting by qualified eye care professional. Over-the-counter decorative contacts, including circle lenses, are illegal and pose a serious danger to your eye heath. They can cause eye injury, eye infection, and vision loss.

    Toric soft contact lenses
    can correct astigmatism, but sometimes not as well as RGP lenses do. They usually cost more than other contact lenses.

    Bifocal or multifocal contact lenses
    are available in both soft and RPG varieties. They can correct nearsightedness, farsightedness and astigmatism in combination with presbyopia. Cleaning and disinfection are specific to the lens material. Visual quality is often not as good as with single vision lenses; however, for some people the ability to correct presbyopia is worth it.


    Source: American Academy of Ophthalmology, www.geteyesmart.com

  • OPTICAL SERVICES

    Optical Services

    We carry many brand name frames including:
     

    Marchon Logo

    Safilo logo

     

     sophia lorenTurboflex

     

    and many others...

    We specialize in fitting childrens glasses featuring frames with flexibility, and comfort cables all with a one year warranty.

    We have many lens options, including transition, crizal anti relflective coating, scratch resistant as well as top of the line
    progressive lenses.

    Our optician has over thirty years of experience in the field and works well with children.

    Patient satisfaction is our goal.
     

  • OCULAR ALLERGIES

    Ocular AllergiesConjunctivitis is the term used to describe swelling (inflammation) of the conjunctiva — the thin, filmy membrane that covers the inside of your eyelids and the white part of your eye (known as the sclera). Often this condition is called "pink eye."

    The conjunctiva, which contains tiny blood vessels, produces mucus to keep the surface of your eye moist and protected. When the conjunctiva becomes irritated or swollen, the blood vessels become larger and more prominent, making your eye appear red. Signs of pink eye may occur in one or both eyes.

    There are three types of conjunctivitis: 

    Bacterial conjunctivitis
    This is a highly contagious form of pink eye caused by bacterial infections. This type of conjunctivitis usually causes a red eye with a lot of pus. 

    Viral conjunctivitis
    The most common cause of pink eye is the same virus that causes the common cold, and is also very contagious. 

    Allergic conjunctivitis
    This form of conjunctivitis is caused by the body's reaction to an allergen or irritant. It is not contagious. 
     

    Source: American Academy of Ophthalmology,  www.geteyesmart.com

  • DRY EYE SYNDROME

    Dry Eye When you blink, a film of tears spreads over the eye, making the surface of the eye smooth and clear. Without this tear film, good vision would not be possible.

    Sometimes people don't produce enough tears or the right quality of tears to keep their eyes healthy and comfortable. This condition is known as dry eye.

    The tear film consists of three layers:  

    • An oily layer;
    • A watery layer;
    • A layer of mucus.

    Each layer has its own purpose. The oily layer, produced by the meibomian glands, forms the outermost surface of the tear film. Its main purpose is to smooth the tear surface and reduce evaporation of tears.

    The middle watery layer makes up most of what we ordinarily think of as tears. This layer, produced by the lacrimal glands in the eyelids, cleanses the eye and washes away foreign particles or irritants.

    The inner layer consists of mucus produced by the conjunctiva. Mucus allows the watery layer to spread evenly over the surface of the eye and helps the eye remain moist. Without mucus, tears would not stick to the eye.

    Normally, the eye constantly bathes itself in tears. By producing tears at a slow and steady rate, the eye stays moist and comfortable.

    The eye uses two different methods to produce tears. It can make tears at a slow, steady rate to maintain normal eye lubrication. It can also produce a lot of tears in response to eye irritation or emotion. When a foreign body or dryness irritates the eye, or when a person cries, excessive tearing occurs.

    It may not sound logical that dry eye would cause excess tearing, but think of it as the eye's response to discomfort. If the tears responsible for maintaining lubrication do not keep the eye wet enough, the eye becomes irritated. Eye irritation prompts the gland that makes tears (called the lacrimal gland) to release a large volume of tears, overwhelming the tear drainage system. These excess tears then overflow from your eye.
     

    Causes of Dry Eye Syndrome

    Hormonal changes are a main cause of dry eye syndrome, causing changes in tear production. The hormonal changes associated with menopause are one of the main reasons why women are most often affected by dry eye.

    Women outsideConditions that affect the lacrimal gland or its ducts — including autoimmune diseases like lupus and rheumatoid arthritis — lead to decreased tear secretion and dry eye.

    Tear secretion also may be reduced by certain conditions that decrease corneal sensation. Diseases such as diabetes and herpes zoster are associated with decreased corneal sensation. So is long-term contact lens wear and surgery that involves making incisions in or removing tissue from the cornea (such as LASIK).

    Doctor and PatientA wide variety of common medications, both prescription and over-the-counter, can cause dry eye by reducing tear secretion. Be sure to tell your ophthalmologist (Eye M.D.) the names of all the medications you are taking, especially if you are using:

    • Diuretics for high blood pressure;
    • Beta-blockers for heart or high blood pressure;
    • Antihistamines for allergies;
    • Sleeping pills;
    • Anti-anxiety medications;
    • Pain relievers.


    Since these medications are often necessary, the dry eye condition may have to be tolerated or treated with eyedrops called artificial tears. 

    People with dry eye are often more likely to experience the side effects of eye medications, including artificial tears. For example, the preservatives in certain eye drops and artificial tear preparations can irritate the eye. These people may need special, preservative-free artificial tears. 

    Another cause for dry eye is exposure to a dry, windy climate, as well as smoke and air conditioning, which can speed tear evaporation. Avoiding these irritants can offer dry eye relief.
     

    Symptoms of Dry Eye

    Dry eye symptoms usually include:

    • Stinging or burning eyes;
    • Scratchiness;
    • Stringy mucus in or around the eyes;
    • Excessive eye irritation from smoke or wind;
    • Excess tearing;
    • Discomfort when wearing contact lenses.

    Dry Eye Treatment

    An ophthalmologist is usually able to diagnose dry eye by examining the eyes.

    Sometimes tests that measure tear production are necessary. A test called the Schirmer tear test involves placing filter-paper strips under the lower eyelids to measure the rate of tear production under various conditions. 

    Another way your Eye M.D. can diagnose dry eye is by putting special dye drops in the eye then studying how long it takes for dry spots to develop on the cornea. The dye test can also be used to look for certain staining patterns that show any damage to the surface of the cornea.
     

    Source: American Academy of Ophthalmology,  www.geteyesmart.com

  • OCULOPLASTICS AND FACIAL REJUVENATION

    Eyelid Surgery (Blepharoplasty)

    Eyelid surgery (also called an eye lift or blepharoplasty), reduces bagginess from lower eyelids and removes excess skin from the upper eyelids.

    This surgery is usually done for cosmetic reasons. It's also an effective way to improve sight in older people whose sagging upper eyelids get in the way of their vision.

    An eye lift will not eliminate dark circles under the eyes, crow's feet, or other facial wrinkles. It is often done along with other procedures such as laser resurfacing, filler injections, or forehead lifts.
     

    The Eyelid Aging Process

    As skin ages, it gradually loses its elasticity. A lack of elasticity plus the constant pull from gravity causes excessive skin to collect on the upper and lower eyelids.

    Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin can hang over the eyelashes and get in the way of seeing.

    The fat that cushions the eyeball from the skull can also cause bulges in the upper and lower eyelids. The thin membrane that holds the fat in place weakens with age, letting the fat jut into the lids.
     

    Who Is a Good Candidate For Eyelid Surgery?

    The best candidates for an eye lift are people who are in good health and who have realistic expectations. Most are 35 years or older, but if baggy eyelids or droopy eyelids run in your family, you may decide to have the surgery done sooner.

    Eyelid surgery can enhance your appearance and help build your confidence. However, it may not result in your ideal look or alter your facial structure. Before you decide to have surgery, think about your goals and discuss them with your surgeon.
     

    Will the Results of Eyelid Surgery Be Permanent?

    Upper eyelid surgery can last at least five to seven years. Lower eyelid surgery rarely needs to be repeated. Of course, your eyes will still age after the procedure.

    If your lids sag again, a forehead lift rather than another eye lift is often the proper procedure.
     

    How Should I Prepare for Eyelid Surgery?

    You will need to arrange for another person to drive you home after your surgery. You should also have someone stay with you the night of the procedure.

    Expect and plan to stay home from work and limit your activities for several days after surgery while your eyelids heal. Some people have dry eyes after surgery, but that rarely lasts more than two weeks. If you have dry eyes lasting more than two weeks, contact your doctor.

    At home, you should have the following items ready:
     

    • Ice cubes
    • Ice pack (or you can use freezer bags filled with ice, frozen corn, or peas)
    • Small gauze pads
    • Eye drops or artificial tears (ask your doctor to recommend the proper type to meet your particular needs)
    • Clean washcloths and towels
    • Over-the-counter painkillers (which your doctor can recommend)


    Advil, Motrin, Naproxen, Aleve, and aspirin should not be used due to the increased risk of bleeding.

     
    Source: WebMD, www.webmd.com


    Botox®
     

    If you have crow’s feet, forehead lines, or frown furrows, Botox might be what you're looking for. Given by injection, this treatments paralyze the underlying muscle, smoothing skin and reducing wrinkles. The results may last up to 6 months. Find out about how the treatments are administered, what it looks like, and more by calling our Opthalmology Associates of Greater Annapolis at 410-757-2778.

  • GLAUCOMA SERVICES

    ABOUT GLAUCOMA

    Glaucoma is a group of eye diseases which in most cases produce increased pressure within the eye. This elevated pressure is caused by a backup of fluid in the eye. Over time, it causes damage to the optic nerve. Through early detection, diagnosis and treatment, you and your doctor can help to preserve your vision.

    Glaucoma

    Think of your eye as a sink, in which the faucet is always running and the drain is always open. The aqueous humor is constantly circulating through the anterior chamber. It is produced by a tiny gland, called the ciliary body, situated behind the iris. It flows between the iris and the lens and, after nourishing the cornea and lens, flows out through a very tiny spongy tissue, only one-fiftieth of an inch wide, called the trabecular meshwork, which serves as the drain of the eye. The trabecular meshwork is situated in the angle where the iris and cornea meet. When this drain becomes clogged, aqueous can not leave the eye as fast as it is produced, causing the fluid to back up. But since the eye is a closed compartment, your 'sink' doesn't overflow; instead the backed up fluid causes increased pressure to build up within the eye. We call this open (wide) angle glaucoma.

    To understand how this increased pressure affects the eye, think of your eye as a balloon. When too much air is blown into the balloon, the pressure builds, causing it to pop. But the eye is too strong to pop. Instead, it gives at the weakest point, which is the site in the sclera at which the optic nerve leaves the eye.

    The optic nerve is part of the central nervous system and carries visual information from the eye to the brain. This cranial nerve is made up of over one million nerve axons, which are nerve fiber extensions of the retinal ganglion cells. When the eye pressure is increased and/or other inciting factors exist, the optic nerve becomes damaged and the retinal ganglion cells undergo a slow process of cell death termed "apoptosis." The death of the retinal cells and degeneration of the nerve fibers results in permanent vision loss. Early diagnosis and treatment of glaucoma can help prevent blindness.

    TREATING GLAUCOMA

    Glaucoma can be treated with eye drops, pills, laser surgery, traditional surgery or a combination of these methods. The goal of any treatment is to prevent loss of vision, as vision loss from glaucoma is irreversible. The good news is that glaucoma can be managed if detected early, and that with medical and/or surgical treatment, most people with glaucoma will not lose their sight.

    Taking medications regularly, as prescribed, is crucial to preventing vision-threatening damage. That is why it is important for you to discuss side effects with your doctor. While every drug has some potential side effects, it is important to note that many patients experience no side effects at all. You and your doctor need to work as a team in the battle against glaucoma. Your doctor has many options. They include:

    Eye Drops

    It is important to take your medications regularly and exactly as prescribed if you are to control your eye pressure. Since eye drops are absorbed into the bloodstream, tell your doctor about all medications you are currently taking. Ask your doctor and/or pharmacist if the medications you are taking together are safe. Some drugs can be dangerous when mixed with other medications. To minimize absorption into the bloodstream and maximize the amount of drug absorbed in the eye, close your eye for one to two minutes after administering the drops and press your index finger lightly against the inferior nasal corner of your eyelid to close the tear duct which drains into the nose. While almost all eye drops may cause an uncomfortable burning or stinging sensation at first, the discomfort should last for only a few seconds.

    Pills

    Sometimes, when eye drops don't sufficiently control IOP, pills may be prescribed in addition to drops. These pills, which have more systemic side effects than drops, also serve to turn down the eye's faucet and lessen the production of fluid. These medications are usually taken from two to four times daily. It is important to share this information with all your other doctors so they can prescribe medications for you which will not cause potentially dangerous interactions.

    Surgical Procedures

    When medications do not achieve the desired results, or have intolerable side effects, your ophthalmologist may suggest surgery.

    Laser Surgery

    Laser surgery has become increasingly popular as an intermediate step between drugs and traditional surgery though the long-term success rates are variable. The most common type performed for open-angle glaucoma is called trabeculoplasty. This procedure takes between 10 and 15 minutes, is painless, and can be performed in either a doctor's office or an outpatient facility. The laser beam (a high energy light beam) is focused upon the eye's drain. Contrary to what many people think, the laser does not bum a hole through the eye. Instead, the eye's drainage system is changed in very subtle ways so that aqueous fluid is able to pass more easily out of the drain, thus lowering IOP.

    You may go home and resume your normal activities following surgery. Your doctor will likely check your IOP one to two hours following laser surgery. After this procedure, many patients respond well enough to be able to avoid or delay surgery. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, many patients are eventually able to discontinue some of their medications. This, however, is not true in all cases. Your doctor is the best judge of determining whether or not you will still need medication. Complications from laser are minimal, which is why this procedure has become increasingly popular and some centers are recommending the use of laser before drops in some patients.

    The different kind of Glaucoma Laser Surgeries include:

    • Argon Laser Trabeculoplasty (ALT) -- for open-angle glaucoma
    • Selective Laser Trabeculoplasty (SLT) -- for open-angle glaucoma
    • Laser Peripheral Iridotomy (LPI) -- for angle-closure glaucoma
    • Cycloablation

    Traditional Surgery

    Trabeculectomy

    When medications and laser therapies do not adequately lower eye pressure, doctors may recommend conventional surgery. The most common of these operations is called a trabeculectomy, which is used in both open-angle and closed-angle glaucomas. In this procedure, the surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A flap is created that allows fluid to escape, but which does not deflate the eyeball. A small bubble of fluid called a "bleb" often forms over the opening on the surface of the eye, which is a sign that fluid is draining out into the space between the sclera and conjunctiva. Occasionally, the surgically created drainage hole begins to close and the IOP rises again. This happens because the body tries to heal the new opening, as if it was an injury. Many surgeons perform trabeculectomy with an anti-fibrotic agent that is placed on the eye during surgery and reduces such scarring during the healing period. The most common anti-fibrotic agent is Mitomycin-C. Another is 5-Fluorouracil, or 5-FU.

    About 50 percent of patients no longer require glaucoma medications after surgery for a significant length of time. Thirty-five to 40 percent of those who still need medication have better control of their IOP. A trabeculectomy is usually an outpatient procedure. The number of post-operative visits to the doctor varies, and some activities, such as driving, reading, bending and heavy lifting must be limited for two to four weeks after surgery.

    Drainage Implant Surgery

    Several different devices have been developed to aid the drainage of aqueous humor out of the anterior chamber and lower IOP. All of these drainage devices share a similar design which consists of a small silicone tube that extends into the anterior chamber of the eye. The tube is connected to one or more plates, which are sutured to the surface of the eye, usually not visible. Fluid is collected on the plate and then absorbed by the tissues in the eye. This type of surgery is thought to lower IOP less than trabeculectomy but is preferred in patients whose IOP cannot be controlled with traditional surgery or who have previous scarring.

    Nonpenetrating Surgery

    Newer nonpenetrating glaucoma surgery, which does not enter the anterior chamber of the eye, shows great promise in minimizing postoperative complications and lowering the risk for infection. However, such surgery often requires a greater surgical acument and generally does not lower IOP as much as trabeculectomy. Furthermore, long term studies are needed to assess these procedures and to determine their role in the clinical management of glaucoma patients.

    Source: The Glaucoma Foundation, www.glaucomafoundation.org