Our Eye Care Services
We have highly trained and experience doctors preforming specialty and subspecialty care. Please review details on various eye issues below.
A cataract is a loss of transparency or a “clouding” of the lens within the eye. The normal job of the lens is to focus incoming light onto the retina of the eye so that we can see sharp and clear images.
Cataracts are the number one cause of vision loss in people aged 55 and older. A cataract is the result of the normal aging process and depending upon our individual “genetic codes,” there is a point in our lives when each and every one of us would develop a cataract. Other things including injuries, certain types of medicines and diseases such as diabetes can cause or hasten the development of cataracts.
However, cataract surgery is only required when the cataract affects the patients daily visual functions such as reading, driving, watching television or causes significant glare at night or in bright sunlight.
Cataract surgery has made tremendous advances in recent years. Today, it is the most frequently performed surgery for senior citizens in the United States. Cataract surgery has also become one of the most comfortable surgical procedures for a person to experience and the results are overwhelmingly positive with the outcome being the restoration of useful eyesight.
The doctors of the Chicago Eye Institute offer the latest breakthroughs in cataract surgery technology. The cataract can be removed by traditional techniques or using the LenSx laser. No stitches, injections or patches are required in nearly every procedure and the patient usually notices a visual improvement almost immediately.
As part of the cataract operation the cloudy lens that has been removed is replaced with an intraocular lens implant (IOL) to focus the patients eyesight. Chicago Eye Institute patients are now offered various types of IOL’s to meet their personal visual desires. Some patients enjoy mono vision in which one eye is set for distance and the other set for near.
Premium IOL’s offer other options. A multifocal IOL gives the patient improved vision at both distance and near without glasses. If a patient has significant astigmatism that can also be corrected at the time of surgery with either the use of a toric IOL or with incisions created by the lenSx laser.
Glaucoma refers to a group of diseases that have common features including a pressure in the eye (intraocular) which is too high for the health of an individual eye, damage to the eye’s optic nerve, and visual field (sight) loss. Most types of glaucoma affect both eyes at the same time. There are usually no symptoms or warning signs that glaucoma is present. However, early diagnosis and treatment is the key to successfully managing glaucoma and ideally occur before significant damage occurs.
In many ways we should think about glaucoma as we do high blood pressure (hypertension). Neither disease typically causes any symptoms and both harm our bodies without our being aware it is happening. Both of these diseases can cause severe problems if untreated . . . glaucoma can cause partial or complete blindness and high blood pressure can cause stroke and heart attack.
Glaucoma has been called the “sneak thief of sight” because the typical glaucoma sufferer feels no pain or discomfort and is unaware that vision is being lost until the disease is very advanced when central vision is affected. Unfortunately, by the time central vision is affected a great deal of surrounding or peripheral vision has already been lost. With the way our two eyes and brain work we simply do not detect the early loses of peripheral vision in glaucoma. The only way these early changes are detected is through very sophisticated testing from your eye doctor. While the overwhelming majority ( perhaps 95 % ) of patients with glaucoma have one of the common “silent” forms there are very rare cases of “acute glaucoma” which occur with severe eye pain, headache, and perhaps vomiting and the appearance of “haloes” around lights. Any such severe eye problem should cause you to immediately contact your eye doctor.
The front part of the eye is filled with a clear fluid (aqueous humor). This fluid is continually produced within the eye where it circulates and eventually drains out. This fluid is what determines the eye’s pressure and it is easily measured by your eye doctor.
Glaucoma is commonly thought to be a disease of “high eye pressures.” However, it is important to stress that there is no particular “pressure” at which a person automatically has glaucoma. The pressure which your doctor measures in your eyes is just one of the factors which must be considered in deciding whether or not you have glaucoma. Every person’s eyes are different and depending upon other factors such as your age, family history and general health, a particular “pressure” which might not be a problem for others might be too high for your eyes.
Quite simply the eye’s pressure is determined by the internal production and drainage of fluid which comprise a basic “plumbing system.” Like any “plumbing system” if the drain becomes blocked or too much fluid is produced for the “drain” to handle the system backs up and the pressure inside goes up. If a pressure is determined to be too high and is not reduced and maintained at a healthy level for a particular individual it will eventually damage the eye’s optic nerve . . . the pathway by which images are brought to the brain so that “seeing” as we think of it can occur. Uncontrolled, this damage can produce partial and even complete blindness.
The diagnosis of glaucoma involves much more than the measurement of “eye pressures.” The optic nerve is carefully examined and photographed with computerized scans. The peripheral vision is evaluated with sophisticated computerized visual field testing instrumentation.
Once diagnosed glaucoma is treated aggressively with the goal of stabilizing any vision loss which may have occurred and preventing further damage. The first line of therapy is usually the use of various medications in the form of eye drops. These drops may have differing specific affects from reducing fluid production within the eye to enhancing its drainage. It may be that a single type of drop has enough effect to adequately help a given patient while other patients may require multiple types of medication and changes over time.
For those patients for whom medication does not provide adequate control of the disease several types of laser and surgical procedures are available. Selective Laser Trabeculoplasty (SLT) for open angle glaucoma and Laser Peripheral Iridotomy (LPI) for angle closure glaucoma are office based procedures that are often effective in assisting glaucoma control. Traditional surgical procedures including trabeculectomy, glaucoma tube shunt implants and diode laser cyclophotocoagulation are employed when deemed necessary. Recently Microinvasive Glaucoma Surgeries (MIGS) are done in conjunction with cataract surgery to provide additional glaucoma control.
It is important to recognize that glaucoma, like diabetes and high blood pressure, requires lifelong medical care and treatment. Although glaucoma is the second leading cause of blindness in the United States, for the vast majority of glaucoma sufferers, timely diagnosis and treatment allow useful and satisfactory vision to be retained throughout life. Glaucoma affects approximately 5 % of all elders and occurs 5 – 6 times as often in Blacks as it does in whites. It is important to remember that a family history, parents, grandparents, brothers or sisters with glaucoma, increases the likelihood that you may suffer the same problem and so it is especially important to obtain thorough yearly eye examinations.
Age Related Macular Degeneration
Age related macular degeneration ( AMD ) is a progressive breakdown of the macula (central portion) of the retina of the eye. Unfortunately, this degenerative condition specifically targets the macular area of the retina, which provides us with our fine or sharp vision.
AMD is the most common cause of permanent vision loss in people over 60 years of age in our society. The frequency with which people are affected increases with age with perhaps one third ( 1/3 ) of the population being affected to some degree by age 75. The disorder affects Caucasians far more frequently than it does Blacks and Hispanics.
Macular degeneration is capable of causing a loss of our sharpest vision making everyday tasks such as reading, television watching, sewing and driving difficult if not impossible. While many sufferers retain reduced but useful vision the condition may progress to cause what is called legal blindness for some. Fortunately, it does not cause complete blindness, as the peripheral areas of the retina remain unaffected.
There are currently considered to be two (2) general types of AMD. These are referred to as the “dry” and the “wet” forms.
The “dry” form is by far the most common. While it does not cause significant impairment for many sufferers others do experience a progressive and potentially severe worsening of vision. Studies have shown that certain vitamins and antioxidants in diet help prevent or slow the worsening of dry AMD.
The “wet” type is the less common of the two and typically results from new blood vessels growing under the retina which bleed and produce swelling and scar tissue in the macula. It has been found that certain Vascular Endothelial Growth Factors (VEGF) promote the growth of these abnormal blood vessels. It has been shown that injecting anti-vascular endothelial growth factor medications into the eye slows or stops the progression of wet AMD. The patient may require one, or a series of these Anti-VEGF injections. In addition, in some cases, laser treatment may be beneficial to treat wet AMD.The loss of vision can be severe and may be noticed to occur over a brief period of weeks or even days.
AMD is caused by various factors. We know that both genetics and increasing age play a role. Studies have suggested that factors such as high blood pressure, nutrition, smoking and excessive exposure to sunlight may be contributing factors.
Scientific studies conducted in recent years have pointed to nutrition as playing a role in the development of AMD. These studies have found that people with diets rich in certain vegetables, particularly leafy green vegetables such as spinach, are affected less frequently with macular degeneration.
Diabetes is the leading cause of new blindness among working age Americans. The most common cause of this vision loss is “diabetic retinopathy.” Diabetic retinopathy occurs when the disease damages the very delicate blood vessels that supply the eye’s retina and also reduces the amount of oxygen the blood within these vessels is able to supply. It is generally accepted that diabetic retinopathy is more likely to be present the longer an individual has been diabetic.
There are two types of diabetic retinopathy. The most common variety, and fortunately the least damaging, is called “non proliferative (background) retinopathy.” This is generally the earliest form of diabetic retinopathy and causes vessels within the retina to leak and cause swelling. These leaks are usually small and self contained. If they leak directly into the area of central vision (macula), eyesight may become affected. When the “macula” is involved special testing including ocular computerized tomography (OCT) and fluorescein angiography are performed. This type of problem may resolve partially or completely on its own or may necessitate treatment with intraocular injections of medication to stop blood vessel leakage and swelling. Laser treatment may also be required.
”Proliferative diabetic retinopathy” is a very serious condition with a potentially devastating impact upon vision. At this point the diabetes has affected the quality of the body’s blood flow resulting in poor circulation within the eye. Being deprived of a normal oxygen supply the eye tries to help itself by growing new vessels on the retina. Unfortunately, these new vessels are extremely fragile and readily bleed into the rest of the eye. Depending on how much bleeding occurs the individual may feel like he is looking through a dark haze or may even be left with no useful eyesight. If untreated, certain cases may even progress to the formation of scar tissue within the eye leading to detachment of the retina.
The stimulus to the growth of these new abnormal blood vessels is Vascular Endothelial Growth Factors (VEGF). Treatment of proliferative diabetic retinopathy involves intraocular injections of anti-VEGF medication and laser therapy to cause these abnormal blood vessels to regress. If intraocular blood does not resorb or if retinal detachment has developed a surgery called vitrectomy may be necessary to restore vision and reattach the retina.
The important thing for all diabetics to remember is that early diagnosis and treatment of retinal problems is their best chance to prevent significant visual problems. Treatment for such problems is best provided by retinal specialists who, having received extensive specialized training in diseases of the retina, generally treat only patients with such problems.
Routine eye examinations for diabetics are the “key” to such success. Diabetics who do not seek care until they actually suffer vision problems have likely experiencing relatively advanced retinal disease. At such times treatment becomes more difficult and the likelihood of a satisfactory visual outcome is reduced.
The cornea is the dome shaped transparent tissue forming the front of the eye. It serves as the protective covering and helps to focus or refract light waves onto the retina in the back of the eye. In eyes with keratoconus the cornea progressively thins and protrudes in a conical shape leading to blurry vision, ghosting, double vision, difficulty reading and intolerance to contact lenses. This condition often begins when patients are in their 20’s, is often binocular, may be hereditary and can be linked to severe rubbing of the eyes.
If keratoconus is stable it can often be treated with appropriate contact lenses. If contact lenses cannot correct the problem the doctors of the Chicago Eye Institute offer the latest surgical and non-surgical options available.
Cross linking involves treatment with a vitamin, riboflavin, that is applied to the collagen fibers of the cornea to prevent progression of keratoconus.
INTACS are semi-circular clear plastic rings inserted into the cornea to reshape it. This minimally invasive procedure has improved the vision of thousands of keratoconus patients and often avoids or delays the need for corneal transplant. Chicago Eye Institute surgeons have performed more INTACS surgeries than anyone else in the United States.
What Is Refractive Surgery?
A refractive error is a group of eye disorders, such as nearsightedness (myopia), farsightedness (hyperopia) and astigmatism which alters and blurs a patient’s vision. Refractive surgery helps to correct these errors to sharpen one’s sight to its best potential. Refractive procedures reshape the cornea, the clear membrane on the front part of the eye, to give the patient the clearest visual image. LASIK is the most popular of these procedures. PRK is also a popular surgery for correcting one’s vision. Which procedure would work best for you will be determined by you and your ophthalmologist after an initial evaluation. Factors such as the amount of refractive error and corneal thickness will need to be measured to decide upon the best procedure.
At the Chicago Eye Institute, we use the latest FDA approved lasers to deliver customized LASIK/ PRK to each individual patient.
What is LASIK?
LASIK (laser-assisted in situ keratomileusis) is an outpatient procedure performed to correct refractive errors, most commonly nearsightedness. With LASIK, an ophthalmologist uses a laser to create a thin flap in the cornea. The flap is then lifted and a second laser is used to sculpt the cornea. The flap is then placed back into its original position.
Nearsighted patients have a steep cornea which LASIK is used to flatten. On the other hand, farsighted patients use LASIK to achieve a steeper cornea. Astigmatism is an irregularly shaped cornea. LASIK is performed to achieve a more uniform and regular shape eye.
What Can I Expect after LASIK Surgery?
Patients usually experience a significant improvement in their vision after 24-48 hours. Typical follow up is one day, one week and one month after surgery. Drops will be used for a period of about one month to help decrease any inflammation and prevent any infection after surgery. While complications are rare, it is important for close follow up in the first few weeks after any refractive surgery to minimize any problems. Glare, halos and dry eyes are common soon after LASIK but typically dissipate with time.
What is PRK?
PRK (photorefractive keratoplasty), is very similar to LASIK. It is a procedure used to correct for refractive errors. Unlike LASIK however, where a flap of cornea is created, PRK instead, is used to remove the outermost layer of the cornea. The same laser is then used to reshape the cornea and the removed layer is then given time to regrow. The advantages with PRK is that less tissue is utilized and that potential complications with the flap are eliminated. Recovery is prolonged however given the time needed for tissue regrowth. While some patients may not be ideal candidates for LASIK due to thin corneas or certain surface diseases, they may be candidates for PRK.
What Are the Risks of Refractive Surgery?
Overall LASIK and PRK are extremely safe procedures and provide less complications than daily contact lens wear. They are however, still surgeries which can present with risk such as glare and halos, dry eyes, corneal haziness, scarring and infections. In addition, further or repeat surgery may need to be performed to best correct one’s refractive error. You and ophthalmologist will decide the best course of action.
For more information please visit the Academy of Ophthalmology website at www.aao.org
The front of the eye, with the exception of the clear cornea, is covered by a loose layer of tissue called the conjunctiva. In some people the conjunctiva may develop a very prominent and elevated wedge shaped growth called a pterygium which may grow onto the cornea. This growth usually has a white color to it with tiny blood vessels growing quite visibly within it. It is important to note that a pterygium is not a “tumor.” A pterygium may become quite annoying causing redness, irritation, burning and tearing.
It is felt that the most common cause of pterygium growth is excessive exposure of the eyes to bright sunlight, wind and dust. It is strongly advised that people spending excessive amounts of time exposed to strong sunlight and wind wear appropriate eye protection in the form of UV absorbing sunglasses and brimmed hats.
Many people are unaware of the presence of a pterygium until it grows from the conjunctiva well onto the clear cornea at which time it may become very noticeable to them or others. Its growth over the cornea may actually affect vision especially if it begins to reach the central area of the cornea. With such growth the pterygium may need to be surgically removed for either cosmetic or visual reasons. Pterygium removal has a much greater chance of success, including less scarring of the cornea, if done by a specialist in corneal surgery who regularly performs such delicate procedures.
Cosmetic Eye Lid Treatments
Cosmetic eye lid and facial surgery can be performed to dramatically improve one’s appearance. People may be bothered by having an overall “tired look” which usually results from the appearance of the eyes. This may simply be because of prominent forehead lines, sagging eyelids, and drooping eyebrows and eyelids.
Cosmetic treatments and surgery to correct these bothersome conditions offers results which include a softer, more rested and well defined appearance. Injections with Botox to smooth wrinkles and dermal fillers derived from hyaluronic acid add fullness and facial contours. Surgery around the very delicate tissue of the eye is best performed by a surgeon specially trained in Oculoplastic and Reconstructive Surgery. “Oculo” refers to the eye itself and both “plastic” and “reconstructive” refer to sculpting, adjusting and contouring the tissue in the area surrounding the eye.
It is important to note that these procedures are not strictly of cosmetic benefit. For example, the removal of excess skin and fatty tissue from the upper eyelids reduces their weight, thereby eliminating headaches caused by the constant effort exerted to lift the lid and brows.
Basal Cell & Squamous Cell Carcinoma
Skin cancers including as basal cell and squamous cell carcinoma is the most common form of cancer found in North America. It frequently affects people with fair-skin and Hispanics, although it is fairly uncommon in darkly pigmented people. People who work outdoors, especially those who work in sunny climates, are at greater risk of developing basal and squamous cell carcinoma.
Fortunately these skin cancers are considered to be a localized tumors. While it does grow, gradually invading and destroying surrounding tissue, it only rarely spreads (metastasize) to other areas of the body.
It is believed that the ultraviolet radiation ( UV ) in sunlight is the primary cause of basal cell and squamous cell carcinoma. Ultraviolet radiation is absorbed by a pigment in the skin called melanin. Melanin is found to a much lesser degree in fair skinned people than in people with dark complexions, which explains why certain peoples are more susceptible to UV damage.
Basal cell and squamous cell carcinomas can occur anywhere on the body but is most commonly found on the face. In fact, over 90% of them are found on the face. The tumors are very commonly found around the eye or the nose. They begin as small relatively flat “lumps” which over time may develop depressions in their centers with raised edges. In addition, they may continually scab or intermittently bleed.
The diagnosis of basal cell and squamous cell carcinoma are made via microscopic examination of cells removed from the tumor. Since these tumors may develop very slowly, people may not notice them until they are questioned about them at routine health care visits such as eye examinations.
While there are various ways to treat basal cell and squamous carcinomas, surgical removal is considered to offer the best opportunity for total removal and a complete cure. If not completely removed these tumors can recur.
Individuals with fair skin should avoid excessive unprotected exposure to strong sunlight. When outdoors under such conditions it is wise to wear protective hats with adequate brims to protect the face and neck. Over-the-counter sunscreens are strongly recommended as well.