Regular eye exams and vision screenings are an important part of maintaining healthy eyes. Silicon Valley Eye Physicians emphasizes regular, preventative eye care as part of patient treatment. We offer standard eye exams and vision screening services, including screenings for glaucoma, retinal disorders, and diabetes related eye problems. Preventative eye care can help ensure good eye health for you and your family, now and for years to come. Contact us today to set up an exam or screening.
Silicon Valley Eye Physicians is a full spectrum eye care clinic that offers patients a wide variety of treatments and services. In addition to the eye care services, such as the treatment of glaucoma, cataracts, and diabeteic eye disease, we also provide treatment for corneal disorders and dry eye syndrome relief, as well as low vision aids and contact lens sales and fittings. If you have a specific eye condition or eye care need, contact us today to find out how we can serve you.
What Is Glaucoma?
Glaucoma is a common degenerative eye disease that is caused by damage to or excessive pressure on the optic nerve. Nearly 3 million Americans suffer from this disease, but only about half are even aware that they have the disease. The most common form of glaucoma is known as primary open angle glaucoma, or POAG. Closed angle glaucoma, a rare form of the disease, is very serious and requires emergency intervention. A third form of the disease is known as “low tension” glaucoma, a condition in which the patient may have optic nerve damage but have normal intraocular pressure. Without treatment, any form of glaucoma can result in vision loss or blindness.
Symptoms of Glaucoma
Although treatable when caught early, glaucoma has no early warning signs. Until its advanced stages, most patients have no indication that the pressure in their eyes may be elevated or that their optic nerve may be damaged. The disease affects peripheral vision first—meaning you could have “perfect” 20/20 vision but still have glaucoma. In POAG, peripheral vision is gradually lost, while central vision is usually spared. Those with POAG might notice excessive fluid in their eyes. Open angle refers to the eye’s drainage system being open, but it is still not able to drain the fluid as fast as it is produced. Although closed angle glaucoma is rare, its symptoms typically include red, painful eyes, blurred vision, headache, and nausea. This form of the disease is an ocular emergency requiring immediate treatment.
Who Is At Risk?
Those who are most at risk of having glaucoma are people with elevated intraocular pressure. The symptoms of glaucoma are not noticeable until the advanced stages, and the risk of having the disease increases with age. Anyone who is over the age of 60 is at risk of having glaucoma. Having a relative who suffers from glaucoma is another risk factor. Those who are of African descent, in addition to being over the age of 40, are at risk for having the disease. Anyone who has diabetes is also at risk for having glaucoma. People in these ‘at risk’ groups won’t experience any noticeable symptoms of the disease early on, so it is important to have regular eye examinations.
A professional ophthalmologist diagnoses glaucoma as part of a routine eye examination. The eye doctor will examine the optic nerve for damage and measure the intraocular pressure in the eyes, a painless procedure called tonometry. If glaucoma is suspected, the doctor typically gives the patient a vision test to determine visual acuity for central and peripheral vision. The test takes about 20 to 30 minutes to perform and consists of flashes of light that the patient sees or does not, with the patient pushing a button to alert the doctor when a flash is seen. This method allows the doctor to accurately map the patient’s visual acuity and find the areas where vision may be affected. Checking intraocular pressure alone is insufficient to diagnose glaucoma. To protect your vision, it is essential to have early and regular eye examinations.
Once a diagnosis of glaucoma has been made, treatment depends on the form of the disease and its severity. For primary open angle glaucoma, eye drops are often given to lower the intraocular pressure. Lowering the pressure in the eye may help slow damage to the optic nerve. For closed angle glaucoma, eye pressure must be reduced quickly, either by eye drops or intravenously. In addition, laser surgery may be required to open the eye’s drainage system to allow fluid to drain.
For those cases of glaucoma that have not responded well to other treatment methods, or for patients who are not candidates for laser surgery, traditional surgery is usually recommended. The most common type is filtering surgery, also known as trabeculectomy. During the procedure, a small flap is created in the sclera (white of the eye), allowing for fluid drainage. To keep the flap from healing and closing, anti-scarring medicine is also administered. More than 85 percent of patients find this surgical method successful. Another surgical option is valve implantation. During this procedure, a silicone tube is placed in the front chamber of the eye. Fluid then drains through the tube to a small reservoir on the side of the eye. This method has a success rate greater than 80 percent.
The best way to keep glaucoma from robbing you of your eyesight is to have early and regular eye examinations by a professional ophthalmologist. Simple and painless, an eye exam will alert you and your eye doctor early on so that an appropriate course of treatment can be taken. Early detection of glaucoma means more effective treatment of the disease. If you notice any of the following warning signs of glaucoma, please contact your ophthalmologist immediately:
- Loss of peripheral vision
- Blurred vision
- Red, painful eyes
- Halos around lights
For further information about glaucoma or to set up an eye exam, please contact Silicon Valley Eye Physicians today.
Diabetes is one of the most common culprits of eye problems in the United States. Diabetes, which causes changes in blood vessels, can cause fluid to leak into the eye and can even induce inner-eye bleeding. This damage can eventually cause irreversible vision loss and blindness if not treated. Luckily, however, if caught early, diabetic eye disease can be treated with laser therapy. With proper check-ups, preventative care, and appropriate treatment, extensive damage can be avoided.
What Is Diabetic Retinopathy?
Diabetic retinopathy is a complication of diabetes in which the retina of the eye is damaged from diabetes. According to the National Institute of Health, diabetic retinopathy is a leading cause of blindness in the United States. Those who suffer from diabetes have high levels of blood sugar, a condition that can cause damage to blood vessels that supply the retina of the eye. The affected blood vessels can begin to leak, reducing the blood supply to the retina.
The Effects of Diabetes on the Eye
Decreased blood flow to the retina starves it of oxygen. As the disease advances, new blood vessels will grow, but they will be weak. These newer, weaker blood vessels often break and leak fluid into the retina’s center, called the macula, causing vision loss that can range from mild to quite severe. This stage of the disease is called proliferative diabetic retinopathy. At any stage of diabetic retinopathy, a swelling of the macula – the central part of the retina – can occur, a condition known as macular edema. If left untreated, diabetic retinopathy can result in permanent vision loss.
The Warning Signs of Diabetic Retinopathy
No symptoms are noticed early on, but as diabetic retinopathy progresses, loss of vision and blindness can result. As abnormal blood vessels leak fluid into the eye, the retina can swell, and vision often becomes blurred. However, it is possible that no symptoms at all will be noticed, even when considerable damage has already occurred.
Treating Diabetic Retinopathy
Laser surgery is the most common treatment for both macular edema (swelling of the retina) and proliferative diabetic retinopathy. The laser seals the leaking blood vessels and stops their growth. This treatment improves vision and prevents further vision loss by helping reduce swelling of the retina and inhibiting new blood vessel formation in the retina. This in-office procedure can be done in less than 30 minutes and is painless.
Sometimes, a vitrectomy is performed to treat an unabsorbed intraocular hemorrhage. During this procedure, blood and the vitreous humor – the natural, gel-like substance within the eyeball – is removed and replaced with air or other gases, which keeps the retina in place. More vitreous humor forms naturally, gradually replacing the air that was introduced.
Prevention of Diabetic Retinopathy
The damaging effects of diabetic retinopathy can be avoided or mitigated with an annual comprehensive eye examination by an ophthalmologist. In addition, diabetics are strongly encouraged to see their eye doctor at least yearly for a dilated fundoscopic exam to check for signs of diabetic retinopathy. Early detection and treatment are crucial elements of protecting your eyesight. For more information about diabetic retinopathy, please contact Silicon Valley Eye Physicians today.
The Natural Lens
The eye’s natural lens is the transparent structure located immediately behind the colored portion of the eye (iris). The lens consists of an elastic capsule filled with a clear paste-like protein.
With aging, the natural clear lens clouds and hardens. This prevents light from reaching the retina and the ability to focus on the retina. Trauma, heredity, diabetes, and even some medications could also cause the clouding. Cataracts result in blurred or fuzzy vision and sensitivity to light. Cataract formation can affect one or both of the eyes at the same or different rates. The rate can be so gradual that the patient may not even realize the vision has gone down.
Types of Cataracts
1. Congenital – from birth of prematurity
2. Acquired – from disease from eye or body
3. Traumatic – injury
4. After Cataract – after surgical implant or cataract
Cataract Surgery (Removing the Clouded Lens)
In order to remove the cataract and replace it with a new lens, incisions are made either on the clear cornea or the sclera. The extent of the incision depends on the technique chosen for the cataract removal.
This procedure requires a small incision of only 3.2 mm or less on the cornea. A small ultrasonic probe is then inserted into the eye. This probe breaks (emulsifies) the cloudy lens into tiny pieces and gently sucks (aspirates) those pieces out of the eye. The incision generally does not require stitching.
- Extracapsular cataract extraction
This method requires a large incision of 10-12 mm in length in the scleral part of the eye. It removes the cloudy lens in one piece. The posterior (back) part of the lens capsule is left behind to support the intraocular lens (IOL). The incision is closed with stitches.
Restoration of Vision
If the cataracts are not limiting activities at the time of diagnosis, the patient could wait before having them removed until the cloudiness progresses to the point that it interferes with the daily routine or totally blocks vision. Cataracts are then surgically removed. The lost optical power is replaced by an appropriate lens, either with a plastic (hard), silicone or acrylic (foldable) intraocular lens (IOL). Both steps are generally done at the same time.
What to Expect
In most cases of cataract diagnosis, a patient has come to our office for an eye examination. The patient has some visual complaints that cannot be corrected with a new glasses or contact lens prescription.
- Night vision is not as good as before.
- The patient is having difficulty with headlight and/or streetlight glare.
- The patient sees halos around lights.
- Print has become blurrier.
- The patient cannot see the TV as well.
- Colors may seem dull.
- The patient fails their DMV eye test.
- The patient’s vision is 20/50 or worse in both eyes.
The doctor's technician will then test the patient’s vision with various tests and then dilate the eyes for an internal look at the natural lens of the eye and the back of the eye (retina).
At this point, the doctor looks at these test results and determines the patient has a cataract in each eye, with varying degrees of density and type of cataract. The doctor explains to the patient why he or she is not seeing well, then asks the technician or surgical coordinator to explain the process.
The surgical coordinator then explains why the patient may need surgery to improve visual function for activities that the cataract could limit. The type of replacement lens will also be discussed with the patient—whether to have an Array or Monofocal lens.
When the patient has decided to go ahead with surgery, the surgical coordinator then schedules a date for the patient. Our doctors perform surgery at three different facilities: El Camino Surgery Center (the main facility we use, next door to El Camino Hospital), El Camino Hospital, and Forest Surgery Center (near O' Connor Hospital). The standard type of anesthesia is called MAC, in which the patient is lightly sedated through an IV. Some patients prefer local (topical) anesthesia. This is available also.
Preoperative History and Physical
Once the date has been determined, the patient will then need to make an appointment with their primary care physician (PCP) within 30 days of the surgical date. This is to determine that the patient is healthy enough for surgery. This is called a preoperative history and physical (H&P). If you have already had a complete physical within a year, then you will only need a short appointment. However, each PCP is different and he or she may have individual requirements. An ECG (heart monitor test) will be required if you have high blood pressure or any type of heart disease.
You may be required to have a blood test if you are taking a potassium depleting diuretic/blood pressure medication. Your PCP may require other tests. You will also be asked to stop any medication that has aspirin, non-steroidal anti-inflammatories, or blood thinners (Tylenol is OK) for one week prior to your surgery date (see list of medications), and you will need to seek approval from your PCP to stop these medications. You will either be given paperwork to give to your doctor or we can fax this to the PCP if the appointment was made over the phone.
Click here for a list of medications that contain aspirin or nonsteroidal anti-inflammatory agents.
The surgical coordinator will then determine if prior authorization is needed before surgery from your insurance. (Medicare does not require prior authorization.)
If authorization is not required, then an appointment will be made for PreOp instructions and Ascan biometry here in our office. If prior authorization is required, then we will contact you by phone as soon as we receive approval for the surgery and the PreOp appointment.
PreOp and Ascan Measurement Appointment
(This appointment will take approximately one hour)
A qualified technician will take measurements to help determine the power of the implant that will be inserted in the capsule that once housed your cloudy lens (cataract). The technician will measure the surface of your cornea and power or curvature. We use two tests to determine the power, an automatic K-reading computer. The diameter of the cornea will also be measured. The Ascan biometer is used to determine the length of the eye with ultrasound (using sound waves). These tests do not hurt! We use the latest, technologically advanced IOL calculation formulas to determine the power of the implant that will be used in your eye.
Preoperative and Postoperative Instructions
You will be given written instructions on what to do prior to surgery and after. We will go over these instructions step by step with you. You will be given a kit with drops, dark glasses, and an eye shield to take home with you. You will put some drops in your eyes one hour prior to arriving at the surgical center and you will begin taking drops when you arrive home after surgery. You will be taking these drops for approximately three weeks after surgery. The quantity of drops instilled will taper down each week, unless otherwise instructed by your physician. We will be seeing you for appointments on the day after surgery and again in approximately 2-3 weeks. Sometimes additional appointments may be necessary. On the 2-3 week appointment you may be prescribed a new reading lens, if required. If you do not have a multifocal lens implanted, you can expect your reading to be blurry in that eye until a new lens can be dispensed.
Location of Surgical Center
El Camino Surgery Center
2480 Grant Road
Mountain View, CA 94040
Please expect a phone call 2-3 days prior to surgery from a nurse at the surgery center to go over your overall health and medications and answer any questions.
Yag Laser Treatment
The capsule holding the IOL may become cloudy weeks or years after surgery. A laser can be used to create an opening in the capsule, reducing the clouding and allowing light to enter, thereby improving your vision. This is a short procedure, which takes a few minutes after the eye has been dilated. You can usually go home within an hour after treatment and you will be seen back in the office about a week later to check the vision and pressure of the eye.
Research is currently under way to find the cause of this clouding of the capsule that holds the IOL.