Frequently Asked Questions
What are the different types of eye doctors?
When it comes to examining and treating vision, there are different types of eye doctors.
The American Optometric Association defines Doctors of Optometry, or optometrists, 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 minor surgical procedures.
An ophthalmologist is a medical doctor who provides the initial diagnosis of several vision-related conditions, including wet AMD. He or she also specializes in diseases and surgery of the eye and may make referrals to a retina specialist for tests and treatment for retina-related issues.
An ophthalmologist is a medical specialist, (MD or DO), who has completed medical school and extensive training and specializes 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.
A retina specialist is an ophthalmologist who has additional training in the diagnosis and management of diseases of the retina and vitreous. If you have a retina-related condition such as wet AMD, it is important to see a retina specialist for the most appropriate care.
What are floaters?
Floaters can be strands of grouped collagen that make up part of the gel in the eye (known as the vitreous), or remnants of tissue when our eyes are first developed. These are not fully transparent and will block some light, as when light comes into the eye a shadow of these things floating around in the gel is seen. 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 objects clear the closer that we hold them. When reaching the age of 40-45, the lens inside the eye becomes stiffer and is less able to change its shape and focus up close. Holding things farther away helps to keep things clear. This is called presbyopia. 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.
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, hardened cataracts were considered “ripe” and ready to be removed. With modern technology, we do not need to wait for the lens to harden for cataracts to be removed. 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, but generally we wait until the patient’s visions is bothered before removal occurs. 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, after which it is removed. 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 most cases, patients return to normal activity the day after surgery, with their vision sometimes being a little blurry right away, improving in the first several days post-surgery. If the patient has 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 a laser?
The vast majority of cataract surgery is performed using ultrasound technology, not lasers. A laser system for cataract surgery is currently in development, which will not actually remove the cataract but will instead help the surgeon prepare the eye for 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, making it look to the patient like the cataract has returned. This membrane is removed through an in-office laser procedure called a capsulotomy.
What are the different types of intraocular lenses (IOLs)?
Ophthalmologists have been implanting intraocular lenses (IOLs) for almost 40 years. During that time, many refinements have been made to lens implants, with today’s lenses providing high levels of safety and clarity. With traditional lens implants, many patients see well without glasses for distance, but require glasses to see nearby objects.
Over the last few years, special lens implants have been designed that help patients avoid using glasses after surgery. One of these, a toric IOL, corrects astigmatism and gives the best chance of seeing well at a distance without glasses after cataract surgery, though glasses correction for reading is still needed (as is the case with traditional lens implants). Multifocal or premium lens implants are used to decrease or eliminate the need for distance and reading glasses.
What is LASIK?
Laser In-Situ Keratomileusis (LASIK) is a surgical procedure to correct vision during which the shape of the cornea is permanently changed. The goal is to improve vision in order to decrease dependence on glasses and contacts, and several variations of the procedure exist, including iLASIK (discussed below).
Is it safe?
Yes, LASIK is a very safe procedure, with problems rarely arising. The procedure is FDA approved for treatment of nearsightedness, farsightedness and astigmatism, and we perform our iLASIK procedures in a clean, hospital environment with each patient being 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 iLASIK™ surgery itself.
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, although a few patients experience mild refractive changes over time.
How long does the procedure take?
The procedure takes 15-20 minutes, with the laser time during the procedure generally occurring less than 1 minute per eye.
Am I a candidate?
If your eyes are in good health and your vision is stable, you most likely are a LASIK candidate. Consult with one of our doctors to see if iLASIK refractive surgery at Cedar Valley Eye Care (a type of LASIK described below) is right for you.
I wear bifocals. Will LASIK work for me?
Yes. We have performed LASIK on hundreds of patients who wore glasses with bifocals, many of whom have special issues that need to be addressed. At Cedar Valley Eye Care, we pride ourselves on good patient communication, and we will not do surgery until all questions are answered.
What is iLASIK?
iLASIK is a customized laser technique of the LASIK procedure that includes two of the most up-to-date technologies available (intralase flap technology and customized Wavefront treatment), which maximizes results and safety. Drs. Puk, Miller and Petrie pride themselves on offering their patients current refractive surgery procedures that are innovative, effective, and FDA-approved. This advanced technology and customized approach provides patients with individualized corrective vision treatments and improved outcomes.
How is the flap created during the iLASIK procedure?
iLASIK creates an ultra-thin flap on the front surface of the eye via the laser used during the procedure. It uses high-speed pulses that gently separate the layers of the cornea at a specified 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 individual imperfections of your vision. Patients are able to experience better eyesight 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, which is used during the procedure and described below. 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 Wavefront corrections for advanced CustomVue treatment.
What is Wavefront/CustomVue?
Wavefront/CustomVue technology is used in the iLASIK procedure and captures the unique imperfections in your vision that could not have been measured and corrected before. This gives Drs. Puk, Miller and Petrie treatment options that are truly individualized and produces a detailed map of your eye. It also provides 25 times more precision than the standard measurements used for glasses and contact lenses.
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 now makes the procedure available for patients who previously were not candidates for iLASIK.
What does it mean to have dry eyes?
A person is diagnosed with dry eyes when the tear glands do not produce enough tears, the tears produced are of poor quality, or the tear ducts drain too many tears off the eye surface. Any of these problems can cause eyes 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.
Your eyes have two different types of tears: reflex and lubricating tears. Reflex tears are produced with injury, emotion, or sudden irritation. When your eyes are irritated, reflex tearing is triggered, causing a flood of tears. Because these tears lack the proper lubricating composition, the discomfort persists, and watery eyes can be a symptom of dry eye syndrome. Lubricating tears are produced continuously, moistening the eye and helping to fight infection.
What are the common causes of dry eye syndrome?
AGING – Approximately 75% of people over the age of 65 suffer from dry eye syndrome, as tear flow normally decreases with age.
DISEASE OR MEDICATION – there are many medications and diseases with side effects that decrease the ability to produce tears.
CONTACT LENS WEAR – tear evaporation is increased significantly with contact lens wear, causing increased protein deposits, discomfort and/or infection. Dry eye syndrome is the leading cause of contact lens intolerance.
ENVIRONMENTAL CONDITIONS – exposure to air pollution, high altitude, smoke, dry, wind, sun, or dry air conditions increase your chances of experiencing dry eye syndrome.
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, or prescription eye drops for some people. 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. 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 different types of punctal plugs available, and your eye care provider will discuss which is best for you.
What is the most common cause of diabetic eye disease?
Diabetic retinopathy is the most common cause of diabetic eye disease, which can cause changes in the blood vessels of the retina that is a leading cause of blindness in American adults. Retina blood vessels may also swell and leak fluid, or grow on the surface of the retina, in some people with diabetic retinopathy.
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 and in more advanced cases, progression of the disease may not produce symptoms. Blurred vision may develop if the central part of the retina (the macula), which is responsible for sharp, central vision, swells from macular edema, or leaking fluid. If new blood vessels grow on the surface of the retina, they can bleed and obscure vision. This is why yearly eye exams are vital for everyone, particularly diabetics. Diagnostic treatment by a fellowship-trained retina specialist is critical to help preserve and potentially improve the vision for someone with diabetic retinopathy.
What is AMD?
AMD is a chronic condition that causes central vision loss, affecting millions of Americans and serving as the main cause of blindness in people age 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 (discussed more below). Dry AMD is the less serious form and usually develops slowly over time, while 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 appears
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
- 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, which can cause a gradual or sudden loss of central vision. If you experience a sudden change or loss of vision, it is imperative that you call your eye care provider immediately.
What are signs and symptoms of macular degeneration?
Fuzzy vision, a 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.
Are there different types of macular degeneration?
Macular degeneration consists of two forms: dry and wet. The dry form is the most common type, affecting about 90 percent of macular degeneration patients. It is caused by the depositing of pigment in the macula (the part of the retina responsible for clear central vision), thinning, and aging of macular tissue.
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. Early diagnosis increases the chances are of preserving the patient’s vision.
What is a retina specialist?
A retina specialist is a MD, a board-certified, fellowship-trained ophthalmologist (an 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 have completed an ophthalmology residency, they do not perform cataract surgery or prescribe glasses and focus their practices exclusively on the practice of medical and surgical diseases of 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 and a negative pressure or suction keeps the retina attached. Retinal tears allow the fluid to gain access to the potential space under the retina and detach it from the eye wall, resulting ultimately in total detachment, and are potentially blinding if not repaired. An important factor in repairing a detached retina is whether the macula (the part of the retina responsible for central reading vision) is detached. Once the macula is detached, vision is rarely the same even after a successful repair.
Some retinal detachments may be repaired in the clinic with the injection of a small 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 retinal detachments occurring in the eye’s top half.
Most retinal detachments require vitrectomy surgical repair and the injection of a large gas bubble. Because the bubble needs to press against the retinal tear, your retina specialist may require you to maintain a strict head position for one to two weeks after surgery. In some cases, a heavy liquid called perfluorocarbon may be used if your retinal tear occurs in the lower half of the eye. 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 the 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, or bleeding within the vitreous gel inside the eye, may occur due to several reasons. Often, a vitreous hemorrhage will leave a patient with significantly decreased vision and is dangerous because your retina specialist is often unable to properly assess the retina for the bleeding’s cause. In cases of significant vitreous hemorrhage obscuring the retina’s view, a retina specialist will perform an ophthalmic ultrasound examination to determine whether the retina is attached. If a vitreous hemorrhage is caused by a retinal tear, your specialist might be unable to diagnose and treat the retinal tear in order to prevent a potentially blinding retinal detachment. Generally, some hemorrhages may be carefully followed in clinic but some require vitrectomy surgery to remove.
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 must be placed within your eye at the end of surgery.
Are daily disposable contact lenses worth the extra money?
These type of contact lenses are a great option health-wise, as there is a reduced 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?
Due to the material underlying extended wear lenses, 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 lenses sit on your eyes, making them subject to existing safety guidelines. 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 during a contact lens fitting. Once the correct fit is determined, contact lens instruction, including insertion, removal, and contact lens care, is required.
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 carry luxury eyewear, including Tiffany®, Judith Leiber®, Fred®, Silhouette®, Gucci®, Dior®, and other frame lines.
How many frames do you currently carry?
We usually have about 1,200 frames on display.
How do you get wrinkles?
We develop two types of wrinkles on our faces:
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 and are commonly found around the lips, the corners of the eyelids (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.
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 sink, causing facial skin to stretch and sag. Unfortunately, while BOTOX cannot treat crèpe-paper wrinkles, other procedures may be used to reduce the appearance of these wrinkles.
How does BOTOX work?
Botulinum toxin (BOTOX) is extracted from the bacteria Clostridia botulinum and has historically been used as a nonsurgical treatment for uncontrollable facial spasms and disorders of the eye (such as misaligned eyes). Now BOTOX is used as a safe and effective way to reduce facial wrinkles without surgery.
BOTOX is targeted directly at the facial muscles that cause dynamic wrinkles to form through a protein injection that 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 also be applied to your skin to decrease the sensation of the injection. 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 of the most recent injection 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. Those who 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.