General Questions

  • What are the different types of eye doctors?

    When it comes to examining and treating vision, there are a few types of eye doctors.


    The American Optometric Association defines Doctors of Optometry as: primary health care professionals who examine, diagnose, treat and manage diseases and disorders of the visual system, the eye, and associated structures as well as diagnose related systemic conditions. They prescribe glasses, contact lenses, low vision rehabilitation, vision therapy and medications as well as perform certain surgical procedures.

    A medical doctor who may have been the first one to diagnose your wet AMD. He or she specializes in diseases and surgery of the eye and may have referred you to a Retina Specialist for tests and treatment.

    An ophthalmologist is a medical specialist (Physician-D.O. or M.D.). He or she has completed medical school and extensive training specializing in the diagnosis and treatment of refractive, medical, and surgical problems related to eye diseases and disorders. The ophthalmologists perform major surgeries such as cataract, glaucoma, lasik, and retina surgery. An optometrist would not.

    Retina Specialist
    An ophthalmologist who has additional training in the diagnosis and management of diseases of the retina and vitreous. If you have wet AMD, it is important to see a Retina Specialist for the most appropriate care.

  • What are floaters?

    Floaters can be stands of collagen which have clumped together that make up part of the gel in the eye, or remnants of tissue when our eyes are first developed. These are not fully transparent and will block some light. When light comes into the eye, what is seen is a shadow of these things floating around in the gel. They are most noticeable in a brightly lit room while looking at a plain white wall, but are always there. We just don’t notice them all the time.

    Floaters can be very annoying, but they do not hinder the health of the eye. However, if you experience a sudden increase in the number of floaters seen or if you experience flashes of light in your vision, you should seek immediate care from your eye doctor.

  • I have to keep holding reading material farther away since turning 40 years old. Why?

    Eyes have to focus harder to keep things clear the closer we hold them.  When reaching the age of 40-45, the lens inside the eye becomes stiffer and is less able to change it’s shape and focus up close.  Holding things farther away helps to keep things clear. This is called presbyopia. “My arms aren’t long enough” is a common complaint among people in their 40s. Reading glasses, bifocals, or contact lenses can take care of this problem. See your eye care professional to find out which option would best for you.

Cataract Questions

  • What is a cataract?

    When the natural lens inside the eye becomes discolored and cloudy, it is called a cataract. It prevents a clear image from forming on the retina.

  • When should a cataract be removed?

    In the past we referred to cataracts as “ripe” when they were hard enough to be removed. With modern technology, we do not need to wait for the lens to harden.  Instead, the time to have a cataract removed is when you can no longer see well enough to do the things you want to do. In rare cases an ophthalmologist may state that a cataract should be removed for reasons involving the health of the eye. However, the majority of the time we wait until the patient is bothered by his or her vision. If you are not bothered by your cataracts, then with a few exceptions, you do not need to have them removed.

  • How is a cataract removed?

    After a tiny incision is made into the eye, the surgeon uses ultrasound to break up the cataract, and then removes it. The back part of the lens membrane (the posterior capsule) is left in place. An intraocular lens (IOL) is then inserted.

  • What restrictions will I have after cataract surgery?

    In the majority of cases, patients return to normal activity the day after surgery. The vision will sometimes be a little blurry right away, improving in the first several days after surgery.  If there is astigmatism, then the vision will be somewhat blurry until new glasses are fitted, which is usually done about a month after cataract surgery.

  • Is a cataract removed with laser?

    The vast majority of cataract surgery is performed using ultrasound, not laser. A laser system for cataract surgery is currently in development. This system will not actually remove the cataract. Instead, the laser will help the surgeon prepare the eye for cataract surgery by making incisions and dividing the cataract into smaller pieces. This will allow the surgeon to remove the cataract using slightly less ultrasound power.

    After a cataract is removed, the membrane (posterior capsule) behind the lens implant can become cloudy. This will look to the patient like the cataract has returned.  This membrane is removed by a laser procedure called a capsulotomy. This is performed in the office.

  • What are the different types of intraocular lens (IOLs)?

    Ophthalmologists have been implanting intraocular lenses (IOLs) for almost 40 years. During that time, many refinements have been made to lens implants. Today’s lenses are safe in the eye and give clear vision. With traditional lens implants many patients see well without glasses for distance, but require glasses to see at near.

    Over the last few years, special lens implants have been designed that help patients get rid of glasses after surgery. A toric IOL corrects astigmatism. This gives the best chance of seeing well at a distance without glasses after cataract surgery, though glasses correction for reading is still needed as well as with traditional lens implants.

    Multifocal or premium lens implants are used to decrease or eliminate the need for distance and reading glasses.

Contact Questions

  • Are daily disposable contact lenses worth the extra money?

    These type of contact lenses are a great option health-wise as there is less chance that protein and bacteria will build up on them. The savings benefit is from not having to buy cleaning and disinfecting solution because these lenses are to be discarded at the end of each day.

  • Is there a significant difference between daily wear and extended wear contact lenses?

    Because of the material extended wear lenses are made of, more oxygen is able to reach your eye. Therefore, extended wear lenses are safer to sleep in, although the risk of infection is not eliminated. Daily wear lenses are not recommended to be worn when sleeping.

  • If I am looking for a specific type of contact lens, where can I find it?

    Contact lens purchases require a prescription. If interested in contact lenses, you must first visit your eye doctor for an eye exam and contact lens fitting. Even if you don’t need vision correction and would like colored or novelty contacts, you still need a prescription as contact lenses are considered a medical device.

  • Why do you need a prescription for colored or novelty contact lenses?

    The FDA considers contact lenses to be a medical device because the contact lens sits on your eye. These guidelines exist for your safety. Each person’s eye and each contact lens is different, so the doctor must determine by special testing and examination which contact lens is best for your eyes. This is called a contact lens fitting. Once the correct fit is determined, contact lens instruction including insertion, removal, and contact lens care is required.

Diabetic Eye Disease Questions

  • What is the most common cause of diabetic eye disease?

    Diabetic retinopathy is the most common cause of diabetic eye disease. Changes in the blood vessels of the retina  in this disease is a leading cause of blindness in American adults. Retina blood vessels may swell and leak fluid in some people with diabetic retinopathy. Abnormal blood vessels grow on the surface of the retina in other people.

  • What are the symptoms of diabetic eye disease?

    Very often in the early stages of this disease, there aren’t any symptoms. Pain and changes in vision may not develop until the disease becomes more severe. In more advanced cases, progression of the disease may not produce symptoms. This is why yearly eye exams are of the upmost importance of people with diabetes.  Blurred vision may develop if the central part of the retina (the macula) responsible for sharp, central vision, swells from leaking fluid. When this occurs, it is called macular edema.  If new blood vessels grow on the surface of the retina, they can bleed and obscure vision.  Diagnostic treatment by a fellowship trained retina specialist is critical to help preserve and potentially improve one’s vision with diabetic retinopathy.

Dry Eye Questions

  • What does it mean to have dry eyes?

    A person is diagnosed with dry eyes when the tear glands do not produce enough tears, tears produced are of poor quality, or the tear ducts drain too many tears off the eye surface. Any of these problems can cause the eye to burn, become red, or feel irritated, scratchy, or uncomfortable. Dry Eye Syndrome affects about 20% of the U.S. population and is the most common of all eye disorders.

    Reflex and lubricating tears are the two different types of tears your eyes have. Reflex tears are produced with injury, emotion, or sudden irritation. When your eyes are irritated, reflex tearing is triggered, causing a flood of tears. This type of tears do not have the proper lubricating composition, so the discomfort persists. Watery eyes can therefore be a symptom of dry eye syndrome.  Lubricating tears are produced continuously. They moisten the eye and contain natural infection-fighting components.

  • What are the common causes of Dry Eye Syndrome?

    1. AGING– Approximately 75% of people over the age of 65 suffer from dry eye syndrome. Tear flow normally decreases with age.
    2. DISEASE OR MEDICATION– there are many medications and diseases with side effects that decrease the ability to produce tears
    3. CONTACT LENS WEAR– tear evaporation is increased significantly with contact lens wear. This causes increase protein deposits, discomfort and/or infection. Dry Eye Syndrome is the leading cause of contact lens intolerance.
    4. ENVIRONMENTAL CONDITIONS– exposure to air pollution, high altitude, smoke, dry, windy, sunny, or dry air conditions increase your chances of experiencing dry eye syndrome.
    5. HORMONAL CHANGES IN WOMEN– oral contraceptives, menopause, and pregnancy can contribute to dry eye symptoms
  • What can be done for Dry Eye Syndrome?

    Treatment can be as easy as using artificial tears a few times a day. Sometimes prescription eye drops are needed. Other helpful options include drinking lots of water, using a humidifier, and making sure your lid margins are clean.

    For more persistent cases, punctal plug insertion might be an option your eye care doctor recommends. These tiny devices, occlude the tear duct or punctum (the drainage duct that carries tears away from the eye). When the tear duct is blocked, tears are not able to drain away too quickly. This procedure is routinely performed in the office and is safe, painless, quick, and totally reversible. There are many different types of punctal plugs available. Your eye care professional should discuss which type is best for you.

LASIK Questions

  • Am I a candidate?

    If your eyes are in good health and your vision stable, you most likely are a candidate. Consult with one of our doctors to see if LASIK is right for you.

  • Why choose LASIK?

    The number of people considering refractive surgery is at an all-time high and LASIK is currently considered the procedure of choice. LASIK surgery creates less irritation to the eye than PRK, enabling the cornea to heal more quickly and improving vision more rapidly.

  • Is it safe?

    Yes, LASIK is a very safe procedure. Problems rarely arise. We perform LASIK in a clean, hospital environment. The procedure is FDA approved for treatment of nearsightedness, farsightedness and astigmatism. Each patient is pre-treated with antibiotics to prevent infection. It has been suggested that your eyes are at more risk during your drive to and from your appointment than from the LASIK surgery itself.

  • What is LASIK?

    Laser In-Situ Keratomileusis (LASIK) is a surgical procedure to correct vision. LASIK permanently changes the shape of the cornea. The goal is to improve vision in order to decrease dependence on glasses and contacts.

  • Does it hurt?

    Some people experience mild discomfort that feels like a “bad contact day”. This usually lasts less than one day.

  • Is laser treatment permanent?

    Yes. The laser treatment does not “wear off”. The change to the lens power of the eye is permanent. A few patients experience mild refractive changes over time

  • How long does the procedure take?

    The procedure takes 15-20 minutes. Laser time is generally less than 1 minute per eye.

  • I wear bifocals. Will LASIK work for me?

    Yes. We have performed LASIK on hundreds of patients who wore glasses with bifocals. There are some special issues that need to be addressed in these patients. At Cedar Valley Eye Care, we pride ourselves on good communication. We will not do surgery until all questions are answered.

  • What is Wave Front/Custom Vue?

    Wave Front/Custom Vue technology captures the unique imperfections in your vision that could not have been measured and corrected before. This gives Drs. Puk and Miller treatment options that are truly individualized to your visual needs. It produces a detailed map of your eye – much like a fingerprint, no two are alike. It provides 25 times more precision than standard measurements used for glasses and contact lenses.

  • What does it cost?

    It is $2,300 per eye for LASIK and $2,300 per eye for Wave Front/Custom Vue. Our pricing is all-inclusive with no hidden fees and includes one year of follow-up care.

  • What is iLasik?

    iLasik is a customized laser technique of two of the most up to date technologies available, maximizing results and safety.

    Dr. Puk and Dr. Miller  pride themselves in offering their patients current refractive surgery procedures that are innovative, effective, and FDA approved. iLasik combines intralase flap technology and customized wavefront treatment to offer advanced technique to achieve the best possible outcome. This customized approach provides patients individualized treatment specific to their own unique needs.

  • How is the flap created?

    iLasik creates an ultra thin flap on the front surface of the eye via laser. It uses high speed pulses gently separating the layers of the cornea at a precise depth. This accuracy allows the surgeon to place the flap at a precise position enhancing your individualized treatment.

    Once the flap has been lifted, cool laser pulses are used to gently reshape the cornea and eliminate the specific imperfections of your vision.  Patients are able to experience better quality vision because their unique distortions have been corrected. Along with the potential for crisper, sharper vision, nighttime glare and halo difficulties are reduced with CustomVue technology.

    After the flap and laser treatment has been completed, the flap is positioned, acting as a protective bandage, and heals quickly with little or no discomfort.

  • What is CustomVue and Iris Registration(IR)?

    CustomVue involves using measurements of visual imperfections unique to your eye, to create a road map or fingerprint for the laser to accurately correct the focus of your vision.  Iris Registration (IR) is an additional safety marker, and is the first FDA-Approved, fully automated method of aligning and registering waverfront corrections for Advanced CustomVue treatment.

  • Why iLasik?

    In the past, iLasik surgery used laser pulses that were directly applied to the front surface of the eye. With the progression of technology, it was discovered that using the corrective laser under a thin layer of tissue lifted from the cornea, healing time was reduced, and discomfort was greatly decreased.

    Instead of mechanical instruments, iLasik offers greater safety due to the precision and predictability of using the laser for flap creation. This increased degree of control over flap thickness makes it possible for patients who previously were not candidates for iLasik , to now have the procedure using iLasik technology.

Mascular Degeneration Questions

  • What is AMD?

    AMD is a chronic condition that causes central vision loss. Millions of Americans have AMD. In fact, it is a leading cause of blindness in people aged 60 and older.
    AMD occurs when the macula–the part of the retina that lets you see color and fine detail–becomes damaged. There are two forms of AMD: dry and wet. Dry AMD is the less serious form and usually develops slowly over time. Wet AMD is the more serious form.

  • What are the symptoms?

    The symptoms of wet AMD may include:

    • Straight lines or faces appear wavy
    • Doorways seem crooked
    • A central blurry or blind spot

    The symptoms of wet AMD can appear suddenly or over time. It’s important that you get an eye exam as soon as you notice any symptoms of wet AMD.

  • Who is at risk?

    The exact cause of AMD is not known. Common risk factors of AMD are:

    Age – 60 or older

    • Family history/genetics – If AMD runs in your family or genes, you may have a higher risk
    • Gender – Women are more likely to get AMD
    • Cigarette smoking
    • Cardiovascular disease – High blood pressure, stroke heart attack and heart disease with chest pain
    • Obesity
    • Low levels of nutrients – Vitamins A, C, and E
  • What is macular degeneration?

    Macular Degeneration is a condition in which the central part of the back of the eye (the macula) breaks down. This can cause a gradual or sudden loss of central vision. If you experience a sudden change or loss of vision, it is imperative you call your eye doctor right away.

  • What are signs and symptoms of macular degeneration?

    Fuzzy vision, shadowy area in the central vision, and straight lines that appear wavy are signs of macular degeneration. Regular eye exams before symptoms occur are the key to an early diagnosis. An amsler grid is a useful tool in testing for vision changes.

  • Are there different types of macular degeneration?

    Macular degeneration consists of two forms, dry or wet. The dry form is the most common type.  About 90 percent of patients with macular degeneration have the dry form.  It is caused from the depositing of pigment in the macula (the part of the retina responsible for clear central vision), thinning and aging of macular tissue, or both.

    Wet macular degeneration develops when new blood vessels grow underneath the retina and leak blood and fluid. Retinal cells die from leakage and cause blind spots in the central vision.

  • Is macular degeneration curable?

    There is no cure of macular degeneration. However, treatment can slow or even stop the progression of the wet form. The earlier it is diagnosed, the better the chances are of preserving the vision.

Optical Questions

  • Do you carry electronic focusing eyewear?

    Yes, we are the area’s exclusive dealer for the Empower electronic focusing eye-wear.

  • Do you carry the newest digital free-form progressive lenses?

    Yes, we carry the latest lens designs from Shamir, Carl Zeiss, Varilux, and other lens manufacturers.

  • Do you have luxury eyewear?

    We do have luxury eye-wear. We carry Tiffany, Judith Leiber, Fred, Silhouette, Gucci, Dior, and other frame lines.

  • How many frames do you currently carry?

    We usually have about 1200 frames on display.

Retina Questions

  • What is a retina specialist?

    A retina specialist is an M.D. and board-certified fellowship-trained ophthalmologist (eye physician and surgeon). Two additional years of intense fellowship training specializing in the diagnosis and treatment of medical and surgical diseases of the retina is undertaken upon completion of an approved three year ophthalmology residency. Even though retina specialists completed an ophthalmology residency, retina specialists do not perform cataract surgery or prescribe glasses and focus their practice exclusively to the practice of medical and surgical diseases of the retina.

    Retina specialists are often consulted in the setting of decreased vision that cannot be explained by any changes to the front part (cornea or lens) of the eye. Most permanently debilitating visual diseases involve the retina.

  • What is a tear and detachment?

    Often associated with a posterior vitreous detachment (PVD), a retinal tear may lead to the development of a retinal detachment. As the vitreous gel detaches from the lining of the retina in a PVD, an area of the retina that is inherently weak or unusually adherent to the vitreous gel may break and cause a retinal tear. The retina is attached to the back wall of the eye much like the lining of a pool that is attached to its concrete basin. A negative pressure or suction exists that keeps the retina attached to the eye wall. A retinal tear allows for the opportunity for fluid to gain access to the potential space under the retina and detach it from the eye wall. Retinal detachments will inevitably detach the retina completely and are potentially blinding if not repaired. The most critical factor in visual prognosis in regards to a retinal detachment is whether the macula, or part of the retina responsible for central reading vision, is detached.

    Once the macula is detached, vision is rarely the same even after successful repair. Some select retinal detachments may be able to be repaired in the clinic with the injection of a small but expansile gas bubble inside the eye. The causative retinal tear or tears may then be treated with laser surgery a few days later. This procedure is called a pneumatic retinopexy and is often performed on smaller superior (top half of the eye) retinal detachments.

    Most retinal detachments, however, require surgical repair with vitrectomy surgery and injection of a large gas bubble. Because the bubble needs to press against the retinal tear or tears, your retina specialist may require one to maintain a strict head position for one to two weeks after surgery in order to put “the bubble on the trouble”.

    In some instances, a heavy liquid called perfluorocarbon may be used if your retinal tear or tears are inferior (lower half of the eye) in location. Long-standing and complex retinal detachments may require the use of silicone oil which may remain in the eye for months to years.

    Depending on the urgency with which the retinal detachment requires repair, surgery may be performed as soon as hours after initial diagnosis. With a gas bubble inside the eye, it is critical that one does not engage in air-travel until the bubble is absorbed completely.

  • What is a vitreous hemorrhage?

    A vitreous hemorrhage may occur due to a number of reasons and represents bleeding within the vitreous gel inside the eye. Often times, a vitreous hemorrhage will leave a patient with significantly decreased vision. Some hemorrhages may be carefully followed in clinic but some require vitrectomy surgery to remove. Vitreous hemorrhages are dangerous because your retina specialist is often unable to properly assess the retina for the cause of the bleed. in cases of significant vitreous hemorrhage obscuring the view of the retina, a retina specialist will perform an ophthalmic ultrasound examination to determine if the retina is attached or not. In the event that a vitreous hemorrhage is caused by a retinal tear, your retina specialist might be unable to diagnose and treat the retinal tear in order to prevent a potentially blinding retinal detachment.

    Similarly, should a vitreous hemorrhage occur in a patient with proliferative diabetic retinopathy, a dense amount of blood within your eye would not allow your retina specialist to perform laser surgery to prevent further damage from occurring to the retina. When a vitreous hemorrhage requires vitrectomy surgery, it is often difficult for your retina specialist to tell you preoperatively what your visual potential is likely to be and whether or not a gas bubble will be required to be placed within your eye at the end of surgery.

Botox Cosmetics Questions

  • How do you get wrinkles?

    We develop two types of wrinkles on our faces:

    1. Dynamic Wrinkles
      We are born with dynamic wrinkles, which are associated with the muscles we use for facial expression. As we continuously use our facial muscles to smile, laugh and squint, mild wrinkles appear when we are young, but they become deeper and more noticeable as we grow older. The most common areas where we develop dynamic wrinkles are around the lips, the corners of the eyelids (where the wrinkles are known as crow’s feet), between the eyebrows, and on the forehead. These wrinkles often make people look older and more tired than they actually are. Botox can be used to treat these dynamic wrinkles and make them less noticeable.
    2. Crèpe-paper Wrinkles
      Crèpe-paper wrinkles are caused by sun exposure and aging. As we age or are repeatedly exposed to the sun, collagen (the protein substance found just beneath and within the deep layers of the skin) begins to think, causing facial skin to stretch and sag. Unfortunately, Botox cannot treat crèpe-paper wrinkles. However, there are other procedures that may be used to reduce the appearance of crèpe-paper wrinkles.
  • How does Botox work?

    Botulinum toxin (brand name Botox™) is extracted from the bacteria Clostridia botulinum. For years it has been used as a nonsurgical treatment for uncontrollable facial spasms and disorders of the eye (such as misaligned eyes). Now it is used as a safe and effective way to reduce facial wrinkles without surgery.

    Botox is targeted directly at the facial muscles that are causing dynamic wrinkles to form. The Botox protein injection blocks transmission from the nerve ending to the muscle. As a result, the muscle relaxes, significantly reducing the appearance of wrinkles and muscles on the skin above that muscle. This blocking effect on the nerves usually lasts an average of three to six months, at which time the muscle regains movement and wrinkles reappear.

  • How is Botox administered?

    Using a very fine needle, your doctor injects the Botox directly into the targeted facial muscles. A topical anesthetic cream may be applied to your skin to decrease the sensation of the injection; you should discuss this option with your doctor beforehand. Botox treatments take only a few minutes and are given during a typical office visit.

    The effects of Botox-induced muscle relaxation begin to occur in about three days. By the end of the first week, you will probably notice a significant reduction of the fine lines and wrinkles around the treated areas. Repeat injections of Botox may be given after the effects wear off.

  • Are you a good candidate for Botox?

    The best candidates for Botox treatments are people who are physically healthy, with no history of neuromuscular diseases (such as multiple sclerosis or myasthenia gravis), who are not pregnant or nursing and who are at least 18 years old.

    Some people should not have Botox treatments include those with:

    • Existing weakness in the targeted muscles;
    • Ptosis (drooping eyelids);
    • Deep facial scars;
    • Very thick facial skin;
    • Marked facial asymmetry;
    • Skin disorders around the planned injection sites.

    You should inform your doctor of your medical history and all medications, vitamins and/or herbal supplements you are currently taking before having Botox treatments.