Ophthalmology and Eye Care
Board-certified physicians at DMC provide comprehensive ophthalmic care, as well as subspecialty care in every area of eye disorders. Comprehensive ophthalmology, diagnostic laboratories and optometry in vision centers supplement clinical services.
Whether you need a routine eye exam or surgery, there is a physician who can provide for your eye health care needs.
DMC ophthalmologists provide testing and treatment of many common eye problems. Our services include:
You should have your eyes examined by an ophthalmologist if you have any of these signs or risk factors:
During an eye exam, your ophthalmologist and his or her assistants ask about your current symptoms and review your medical history. Eyedrops to dilate your eyes may or may not be used during the exam.
An eye examination typically evaluates:
Glaucoma is one of the leading causes of blindness and the single most common cause of blindness among African-Americans. Because they at increased risk for glaucoma, people of African descent should see an ophthalmologist even if they have no signs of glaucoma or risk factors.
Ophthalmology vs. Optometry: What’s the Difference?
An optometrist is a health care professional who is licensed to provide primary eye care services, such as:
An optometrist is a Doctor of Optometry, or OD. To become an optometrist, one must complete pre-professional undergraduate college education followed by four years of professional education in a college of optometry. Some optometrists also do a residency.
An ophthalmologist is a medical doctor who specializes in eye and vision care. Ophthalmologists are trained to provide the full spectrum of eye care, from prescribing glasses and contact lenses to complex and delicate eye surgery. They may also be involved in eye research.
After four years of medical school and a year of internship, an ophthalmologist spends a minimum of three years of residency (hospital-based training) in ophthalmology.
During residency, the ophthalmologist receives special training in all aspects of eye care, including prevention, diagnosis and medical and surgical treatment of eye conditions and diseases.
An ophthalmologist may also spend an additional year or two in training in a subspecialty, that is, a specific area of the eye.
Low Vision Services
Anyone whose vision is not considered “normal,” or whose vision interferes with their ability to perform visual tasks related to daily living, hobbies, reading and other activities that make life enjoyable, is a candidate for vision rehabilitation services. These services are provided in addition to any medical or surgical treatments being rendered to the patient.
Vision rehabilitation services include a functional vision assessment. A functional vision assessment measures how well a person uses vision to perform routine tasks in different places and with different materials throughout the day. The functional vision assessment paints a picture of how a person uses vision, what visual skills the person needs to further develop, and their visual function/skills.
Some major elements measured in the exam include:
Once all the information is acquired in the exam, optical and non-optical treatments will be discussed and demonstrated.
Optical options may include glasses, high-powered glasses, magnifiers, telescopes and television magnification.
Non-optical options may include use of illumination, eccentric viewing, scanning and tracking techniques and home marking techniques.
After the evaluation, an individualized plan is formulated for the patient to address his or her visual goals, maximize visual function, to ensure he or she can maintain independence, and ensure he or she can successfully perform activities that are enjoyable.
Glaucoma is fairly common over the age of 35, affecting 2 of every 100 persons. The number of persons affected by glaucoma is expected to rise dramatically as the population of "baby boomers" ages. Glaucoma is one of the leading causes of blindness and the single most common cause of blindness among African Americans.
The best way to protect yourself from glaucoma is through early detection and treatment.
There are several different types of glaucoma, but all types are caused by increased pressure within the eye that can destroy the optic nerve if not treated promptly.
A constant level of liquid called the aqueous humor is maintained in the inner chamber of the eye. Fluid flows into the eye from several structures, and fluid drains from the eye at a spongy outlet located at the angle where the cornea and sclera meet. If the outlet is clogged or if the drainage system is overwhelmed by too much liquid production, a buildup of fluid occurs and causes a pressure increase inside the eyeball.
This places pressure on the optic nerve and its blood supply that can cause serious irreversible damage.
A blockage in the drainage system (and the resulting increase in pressure) can be caused by eye injury, tumor, hemorrhage or infection.
The symptoms of glaucoma vary depending on the specific type of glaucoma:
Chronic open-angle glaucoma
Chronic open-angle glaucoma, also known as chronic simple glaucoma or primary open-angle glaucoma, is the most common type of glaucoma. This type of glaucoma primarily occurs in those persons over age 40 and is symptomless; a "quiet" disease that often causes irreparable damage before it is discovered.
Chronic open-angle glaucoma may develop as a result of gradual aging, causing a decreased drainage capacity. When drainage is reduced, pressure within the eye slowly mounts, harming the optic nerve.
Congenital glaucoma is present at birth or shortly after birth. It is usually caused by a defect in the drainage system. Any infant who has symptoms of increased sensitivity to light or eyes that fill up with tears easily should be evaluated immediately to determine the nature of the problem and to prevent permanent damage to the sight.
Acute angle-closure glaucoma
Acute angle-closure glaucoma, also known as primary narrow-angle glaucoma or acute glaucoma, results from an immediate, complete blockage of the drainage area. The iris may press against the drain area causing sudden obstruction. Without drainage, fluid backs up and eye pressure increases rapidly. Rainbow-like halos or circles around lights, severe pain in the eyes or forehead, nausea, and blurred vision may occur. This type of glaucoma can occur suddenly at any age and is a true medical emergency; immediate professional care is needed to preserve sight. Blindness can result quickly in a day or two without treatment.
Secondary glaucoma occurs as the result of some other health problem of the entire body or of the eye. It may develop rapidly or slowly. If closure of the drainage system occurs rapidly, the symptoms will be similar to those described for acute angle-closure glaucoma. Immediate attention by an eye care professional is needed.
Prevention involves early detection through a comprehensive eye health examination, especially after age 35. Sometimes the level of pressure may be above normal, yet there are no symptoms, so an eye examination is the only way to discover the problem.
During a comprehensive eye examination an instrument called a tonometer is used to check the level of pressure in the eye. It is a simple, painless test that takes a fraction of a second to perform.
As part of your eye examination, your eye care professional can also determine the health of the optic nerve by examining the inside of the eye.
In addition, vision fields are performed to determine the presence of blind spots or shrinkage in the peripheral field of vision.
People with a family history of glaucoma are more likely to develop the problem, as are those who are nearsighted.
Some diseases that impact the entire body, such as diabetes, anemia, or hardening of the arteries, increase the risk of the condition. Persons who do not actually have diabetes, but have a strong family history of the problem, should have their eyes checked frequently for early development of the disease.
African Americans tend to develop glaucoma more frequently than other racial groups.
Damage to optic nerve fibers cannot be reversed. For that reason, sight can only be protected through early detection of the problem. Since glaucoma may grow worse without symptoms, periodic eye examinations for those over age 35 are imperative.
The goal of glaucoma treatment is to prevent further damage and to preserve the highest possible level of vision. Glaucoma is treated by reducing the pressure within the eye. Medications, either pills or eye drops, are used to lower pressure either by causing better drainage of liquid or by decreasing liquid production. Medication usually must continue for life and must be taken regularly to effectively reduce eye pressure.
If medication does not reduce pressure, surgery may be recommended to correct drainage problems. The goal of surgery may be either to form a new drainage channel or open the old channel.
Since glaucoma cannot be prevented, the next best measure to protect sight is early detection and treatment, before optic nerve fibers have been destroyed. This can be accomplished only through regular comprehensive eye health examinations, because glaucoma often is symptomless.
Everyone over the age of 35 should be tested for glaucoma every one to two years or whenever problems exist.
Although there are several different types of cataracts, they are all caused by a loss of transparency in the crystalline lens of the eye. This loss of transparency causes a disruption in the transmission of light to the retina.
Cataracts most commonly occur among people who are over age 55, although it can affect younger people and, rarely, can affect newborns. Twenty-three percent of those over age 75 are affected by cataracts.
On a global basis, cataracts account for over one-half of all cases of impaired vision and affect over 20 million people.
Chemical changes within the protein material of the lens are responsible for clouding and yellowish or brown discoloration. These chemical changes seem to be part of the natural aging process, although they may also be caused by injury, inherited tendencies, certain diseases or birth defects.
Other contributing factors include exposure of the eye to ultraviolet light (sunlight), poor nutrition, cigarette smoking and certain drugs.
The lens is normally clear so light can readily pass through it, producing a sharp image on the retina. When the lens becomes opaque, light can't pass through as easily. Having a cataract is like trying to look through a foggy window.
The cloudy lens blocks the passage of light, thereby casting a blurred image on the retina. Clouding of the lens may affect a small portion of the lens or the entire lens.
Cataract formation may cause little or no visual problem for some people, especially in the early stages of the condition. Others experience a substantial decrease in vision that may require surgery. Severe cataracts may cause a complete loss of functional vision.
The degree to which a person's vision is affected by cataract formation depends on the location and degree of clouding. For instance, if the area of clouding initially starts on the side of the lens, a person's vision may not be drastically affected for years, because peripheral vision is not used as much as the central area. Cataracts typically develop in both eyes, although the rate of progression varies with each eye. The onset of a cataract may be gradual or rapid. Cataracts usually develop around age 50, but may not significantly interfere with sight until much later — age 65 to 75.
There is no known prevention for cataracts that occur as a natural process of aging. However, there is growing evidence that exposure to ultraviolet light (sunlight) and cigarette smoking may speed their development. Avoidance of excessive sun exposure and smoking is a sound preventive measure.
A comprehensive eye health examination is needed to detect cataract formation. After diagnosis, regular follow-up care is needed to assure the best possible correction for the level of impairment.
Prescription glasses can help you see better. At some point, however, cataracts may become so dense that good vision can no longer be maintained with just prescription eyewear. At that time, surgery may be the best option to restore vision.
The decision regarding surgery is one that is made jointly by the patient and the eye care professional. The decision of when to have a cataract removed depends on a number of factors, such as the extent of clouding, the location of the cataract, and the extent to which normal daily activities are impaired. For instance, if reading or driving abilities are impaired, surgery may be a more realistic consideration than if such impairments have not yet been noticed.
Cataract surgery has improved dramatically in the last decade, with a very high success rate of 95 percent or better. Over one million cataract surgeries are performed annually. The surgery has few complications and an increasingly short recovery time. Most of the time, the procedure is done on an outpatient basis.
Because only one eye is operated on at a time, the more impaired eye is usually done first. Surgery is often timed such that the other eye still has adequate vision for one to function until the surgical eye has healed.
Cataract surgery involves the removal of the clouded lens. When the affected lens is removed, focusing power of the lens must be replaced. Often, an artificial lens implant (known as an intraocular lens implant or IOL) will be inserted into the eye immediately after the impaired lens is removed.
Eyeglasses and contact lenses are other forms of lens "replacement." However, since these replacements are not within the eye itself, vision is not as natural.
Sometimes cataract removal does not result in complete improvement in vision because sight is dependent on many other factors, such as the "health" of the retina, which may also be impaired. But, in such cases, proper eyewear can usually further enhance vision to an acceptable range.
Each of these replacements (IOL and prescription lenses) is designed to allow the eye to again focus clearly.
Although no substitute is as good as the real thing — nature's own lens — the availability of replacements certainly is an improvement over earlier days when the development of cataracts simply meant a gradual, progressive loss of vision.
Diabetic retinopathy, the most common diabetic eye disease, occurs when blood vessels in the retina change. Sometimes these vessels swell and leak fluid or even close off completely. In other cases, abnormal new blood vessels grow on the surface of the retina.
When blood sugar levels are too high for extended periods of time, it can damage capillaries (tiny blood vessels) that supply blood to the retina. Over time, these blood vessels begin to leak fluids and fats, causing edema (swelling). Eventually these vessels can close off, called ischemia.
You can have diabetic retinopathy and not be aware of it, since the early stages of diabetic retinopathy often don't have symptoms.
As the disease progresses, diabetic retinopathy symptoms may include:
Diabetic retinopathy symptoms usually affect both eyes.
People with diabetes are at risk for developing diabetic retinopathy. Diabetes is a disease that affects the body's ability to produce or use insulin effectively to control blood sugar levels.
The only way to detect diabetic retinopathy and to monitor its progression is through a comprehensive eye exam.
The best treatment for diabetic retinopathy is to prevent it. Strict control of your blood sugar will significantly reduce the long-term risk of vision loss. Treatment usually won't cure diabetic retinopathy nor does it usually restore normal vision, but it may slow the progression of vision loss. Without treatment, diabetic retinopathy progresses steadily from minimal to severe stages.
Treatment options include:
Laser Surgery of the Eye
Laser surgery has been one of the great advances in treating eye diseases. The success of the laser depends on the type of eye disorder.
In most situations, laser surgery helps prevent further loss of sight, but will not provide great improvement in vision. In a few situations, vision may be restored to normal.
Your ophthalmologist will discuss the risks and benefits that laser treatment can offer you.
There are two different ways that lasers are used to treat eye diseases.
Thermal lasers: The light is converted to heat when it reaches the eye. The heat is used to:
Photodisruptive lasers: The light cuts or sculpts the tissue, similar to a knife. The beam of light is used to:
Laser surgery of the eye has several advantages:
Retinal tears or holes: The retina is the inner layer of the eye that senses light and helps you to see. If the retina tears, it can separate from the back wall of the eye. This is called a detached retina, and it can cause you to lose sight.
Most retinal tears can be treated with the argon or krypton laser, if they are found before the retina detaches. The laser helps bond the retina to the wall of the eye, preventing a retinal detachment.
If retinal detachment has already occurred, the laser may be used to surgically repair the detachment.
Diabetic retinopathy: Eye disease from diabetes is a major cause of vision loss. Diabetes can cause blood vessels in the retina to grow abnormally. The vessels can leak fluid (macular edema) or bleed inside the eye.
Laser surgery to treat diabetic retinopathy:
Macular degeneration: The macula is the small, central area of the retina that allows us to see fine details clearly. Macular degeneration affects your central or reading vision.
Most people have "dry" macular degeneration, which cannot be helped by laser surgery.
A few people have "wet" macular degeneration. Abnormal blood vessels cause bleeding and scarring of the macula. In certain cases, these people may be treated with the argon or krypton laser. The laser seals the blood vessels to prevent further damage.
There are other retina problems that can be treated with the laser, including:
After a cataract has been removed, the capsule of the lens sometimes becomes cloudy. The neodymium-YAG laser can open up this cloudy membrane and restore clear vision. The laser is not used to remove cataracts.
Glaucoma is a disease of the optic nerve, which sends images from the eye to our brain and allows us to see. Glaucoma affects at least two out of every 100 older Americans.
Glaucoma damages the optic nerve, usually because the fluid pressure inside the eye is too high. Loss of vision from glaucoma can often be prevented if your ophthalmologist discovers the disease before much damage occurs to the optic nerve.
Glaucoma must be detected early if treatment is to be successful.
Eye drops or pills are the usual way to treat glaucoma. If they do not control the pressure within the eye, laser surgery may be used to create a tiny opening, allowing the fluid to drain and release pressure.
Visual Field Testing
A visual field test measures how much "side" vision you have. The test determines if you have lost sight from glaucoma and other conditions. Changes in the visual field help to determine if the sight is getting worse and the glaucoma is progressing.
It is a straightforward test, painless and does not involve eye drops. Your head is kept still and you have to rest your chin on a chin rest.
Essentially, lights are flashed on, and you must press a button whenever you see a light. The lights are bright or dim at different stages of the test. Some of the flashes are purely to check that you are concentrating.
Each eye is tested separately, and you should allow 15 to 45 minutes to have the whole test.
These are usually carried out by various optometrists.
Normally the test is carried out by a computerized machine. Occasionally a manual test has to be used. For each test you have to look at a central point and have to press a buzzer each time you see a light.
You need to bring any glasses you have.
The glaucoma technician or optometrist will do the test.
The results are placed in your file and the ophthalmologist will review the notes at your next consultation.
Ophthalmic photography uses specialized equipment to illuminate and make an image of specific structures in the eye.
Also called a fundus camera, a retinal camera allows detailed imaging of the back of the eye. Using fine-grained color slide film, a trained photographer can consistently produce detailed photographs in a short time with minimal patient discomfort.
A type of fundus photography in which a fluorescent, mineral-based dye, fluorescein sodium, is injected into the patient's arm, and a series of photographs is captured as the dye moves through the blood vessels in the eye. Eye doctors then diagnose the patient's state of eye disease based on particular fluorescence patterns in the photographs.
A fluorescein angiogram is a valuable tool for assessing blood flow in the eye. It is well tolerated by patients of all ages, but it is an invasive procedure with some side effects. The dye turns the patient's urine bright yellow for several hours, and patients with light complexions may look a little jaundiced for a few hours.
OCT is a newer technology that has taken the world of eye care by storm. Using low-powered lasers, the OCT makes a cross-sectional picture of the retina. Behind this simple statement is a revolutionary imaging method. Until OCT arrived, eye doctors determined the state of retinal disease based strictly on their exam and on fluorescein angiography.
A slit lamp bio-microscope is the primary examination instrument for the front of the eye: the cornea, lens, conjunctiva (whites of the eye), and the iris. Every eye exam room has one. An eye doctor or ophthalmic technician use a slit lamp to check the overall health of the eye.
A slit lamp camera is a slit lamp equipped with a camera and a flash light source. Slit lamp photography is done to document disease-related changes to these structures.
A slit lamp allows the examiner or photographer to move the light from side to side, to change the size and shape of the light beam, and to change magnification, all in the interest of revealing small structures as clearly as possible.