Transcript The Essentials for Paraoptometric Personnel in

The Essentials for
Paraoptometric Personnel in
Understanding
What We Tell Our Patient’s
About Eye Surgery
Jeff D. Miller, O.D.
Stillwater, Oklahoma
[email protected]
Anatomy of the Eye
Cornea
Pupil
Optic
Nerve
Lens
Macula
Iris
Retina
Cataract Surgery
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A cataract is a clouding or opacification of the natural
crystalline lens of the eye. As the lens becomes darker
and darker the patients visual acuity drops to levels that
limit them from performing their daily activities.
Surgical removal allows restoration of vision and in
most cases the opportunity to choose the patient’s final
prescription through the lens implant power.
Patients can choose to be clear in the distance, have
mono vision or consider a multi-focal (bifocal) lens
implant.
Cataract Surgery
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Cataract surgery has evolved tremendously over the last
25 years. Incisions made on the eye (scleral)have gone
from 10-12 mm to 2-3mm and are now made on the
cornea. Lens implants are now foldable to allow
smaller incisions. These changes improve healing time,
result in less swelling, produce less astigmatism, allow
surgery to be completed without sutures, and can be
done with topical anesthetic (drops) alone. That is, the
patient is awake with only mild sedation from an IV.
Cataract extraction is the most common
outpatient surgery performed in the United
States today. Cataracts are the leading cause
of blindness in the world however, because of
access and healthcare in the USA they are not
a significant cause of “permanent” vision loss
Cataract Illustration and Video
The Future of Implants
Corneal Transplant
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The cornea is the clear dome shaped tissue on the front of the
eye directly in front of the iris.
The cornea is referred to as the window of the eye and must
remain crystal clear or vision can be reduced.
The cornea is responsible for a significant portion of the
“power” or prescription of the eye.
The cornea can become cloudy or opacified for several reasons
including trauma, infection, or corneal disease.
Common reasons for a corneal transplant include herpetic eye
disease, scarring from corneal ulcers, keratoconus, corneal
dystrophies like Fuch’s endothelial dystrophy and trauma,
Anatomy of the Eye
Cornea
Pupil
Optic
Nerve
Lens
Macula
Iris
Retina
Corneal Transplant
Corneal Transplant Video
Presentation
Pterygium Removal
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A Pinguecula and Pterygium – what’s the difference? A
pinguecula (Latin for “fatty”)is a yellowish, raised
growth located on the conjunctiva at 3:00 or 9:00
o’clock. It is commonly thought to be the precursor of
a pterygium. As the mound of tissue (pinguecula)
grows in size and onto the cornea it is then termed a
pterygium.
These are considered degenerative lesions causally
related to chronic long term exposure to sunlight.
If allowed to grow in front of the pupil, scarring can
result in a permanent decrease in vision in addition to
induced astigmatism.
Pterygium Removal
Video Presentation
Glaucoma Surgery
Trabeculectomy
• A trabeculectomy involves removing a tiny piece of the
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eye right at the place where the cornea connects to the
sclera (the white part), and creating a flap to allow fluid
to escape the anterior chamber without deflating the
eye.
Along with that tiny piece of cornea and sclera comes a
piece of iris. The whole area is called the trabeculum.
Fluid can then flow out onto the surface of the eye but
under the conjunctiva, the clear tissue on top of the
white part of the eye or sclera.
The fluid forms a “bleb” on the surface of the eye just
under the top eyelid. The fluid is absorbed by the
conjunctiva.
TRABECULECTOMY
Trabeculectomy
vs.
Shunts or Valves
• Trabeculectomies can scar shut such that the
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drainage of fluid is reduced or stopped and eye
pressure goes back up to uncontrolled levels.
Various drugs have been used to control healing
and scarring over time. Some work on certain
individuals some don’t. (mitomycin C)
Valves or shunts have now become the choice of
many glaucoma specialists because it is less
likely in some patient populations these will fail
over time.
The Ex-PRESS Mini Glaucoma Shunt
Excessive
Pressure
REgulation
Shunt
System
Ex-PRESSTM in a Nutshell
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Consistent
Predictable Results
Reproducible
Minimally invasive
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Consistent lumen
Less inflammation
Less complications
Low diffuse blebs
High success rate
Refractive Surgery
• LASIK or Laser Assisted In-Situ Keratomileusis – is a laser procedure that
simply put, sculpts the curve of your glasses or contact lens right on the
surface of your cornea.
• LASIK is the most popular refractive surgery performed
today in the US.
• This procedure first creates a protective flap on the cornea that is folded
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over and then the Excimer Laser is programmed for that persons
prescription.
The protective flap can be made with an automated device called a
microkeratome or can be made with a laser.
• The procedure takes minutes to perform and is painless.
• Visual acuity recovery is usually rapid with in days to 1 week
The Precision of the
Excimer Laser
1000 microns is equal to 1mm. The average corneal
thickness is 550 microns. The Excimer laser can remove ¼
of one micron with every pulse of the laser. The Accuracy
of this laser is unparalleled throughout the medical field.
THE LASIK PROCEDURE
The corneal flap is created and then
carefully folded back.
THE LASIK PROCEDURE
Laser of cornea
THE LASIK PROCEDURE
Corneal flap is replaced over treated cornea
Final corneal shape with corrected corneal curvature
LASIK VIDEO PRESENTATION
PRK – Photorefractive Keratectomy
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PRK was first performed in the USA in 1987. After the success
of that patient the Excimer Laser was studied for 8 more years
before the FDA approved its use.
LASIK has surpassed PRK as the procedure of choice because
of LASIK’s rapid recovery and lack of discomfort.
PRK is still performed in the US and remains the procedure of
choice in some patient populations
Thin cornea’s, patients with corneal dystrophies, and those at
risk for flap complications have PRK performed.
Healing is longer thus visual recovery is slower however; still
occurs with in 1 week to a month for good vision. There is
more potential for discomfort and because medications,
specifically steroids, are used longer side effects are more likely.
(increased IOP)
PRK
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The procedural difference between PRK and
LASIK is that no flap is created. The top layer
of tissue, the corneal epithelium, is removed and
the laser is then applied to the cornea. A
bandage contact lens is then placed on the
cornea until complete re-epithelialization has
occurred. Vision is blurry during this period.
Once the CL is removed vision begins to clear
and improves over 3-4 weeks.
PRK VIDEO PRESENTATION
Phakic IOL’s or ICL’s
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Phakic – this term refers to the fact that the natural crystalline
lens is still present.
Aphakic – is what a patient is when they have no crystalline lens
in their eye. 35 yrs ago patients were left aphakic after cataract
surgery. They would use very thick +13 and higher prescription
glasses or contacts instead.
Pseudophakic – is what a patient is after they have had cataract
surgery and have an intraocular lens implant in their eye.
Phakic IOL – phakic intraocular lens
(placed in front of the natural crystalline lens behind the iris)
VeriSyse Phakic IOL
ICL’s – Implantable Contact Lens
Visian ICL – Implantable Collamer Lens by Visian
PHAKIC
IOL’s
VeriSyse Phakic IOL
Visian - ICL
Phakic IOL Video Presentation
Chalazion
Chalazion
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A chalazion (meibomian gland cyst) is a chronic,
sterile granulomatous inflammatory lesion
caused by retained sebaceous secretion leaking
from the meibomian glands or other sebaceous
glands.
Internal Hordeolum is a chalazion that is
infected usually by Staph. Aureus bacteria.
Simply put, these are big, deep, pimples that you
can’t express by squeezing them.
MEIBOMIAN GLANDS
Chalazion Removal
Video Presentation