CK is a non-laser treatment most commonly used for baby-boomers who are tired of their reading glasses. A special probe introduces an electrical current to the peripheral cornea, shrinking the corneal fibers. The electrical current acts like a purse-string, causing the central cornea to steepen, thus improving the near vision in the treated eye. The procedure takes less than five minutes and is essentially painless. The major advantage of CK (Conductive Keratoplasty) is its relative safety.
Our experience with CK began during the FDA clinical trials, which began in 1998. While CK gained FDA approval in 2002 for the treatment of farsightedness, we found that the best candidates are patients over the age of 45 with excellent distance vision but with difficulties seeing near items such as their cell-phone, wrist-watch, and price tags. In 2004, CK became the first FDA approved procedure for this indication, known as “presbyopia.”
Many Conductive Keratoplasty patients only need one eye, usually their non-dominant eye, treated. The recovery of near vision is almost immediate, although patients usually notice a decrease in the distance vision of the treated eye which improves with time. Most CK patients may return to work within one to three days following their correction procedure. Because the condition of presbyopia progresses as we age (ie: people need stronger reading glasses at age 65 than at age 45), and because the corneal steepening effect of CK (conductive keratoplaty) can diminish with time, extra CK treatment may be needed within three to five years of the initial procedure. Because of the safety and benefits of CK, the FAA (Federal Aviation Administration) approved the use of CK for pilots.
With improvements in the safety and efficacy of all laser LASIK, many patients who may have considered having CK performed, choose instead to undergo LASIK to improve their reading vision. Additionally, improvements in lens implant technology have provided patients desiring to see without reading glasses further surgical options. As a newer potential indication CK, since 2014 we have been studying the effect of CK in attempting to improve vision for patients with keratoconus. As part of an investigational clinical trial, CK is performed in combination with corneal collagen crosslinking. Please note, this combined procedure is not FDA approved and is performed only as part of a study protocol.
Call us today at 818-883-0112 or fill out our online form to schedule a Conductive Keratoplasty consultation. If you would like to read without glasses but are not a candidate for Conductive Keratoplasty (CK), you may wish to consider the various laser vision correction or lens implant procedures.
Comprehensive Eye Exams
What to Expect from a Comprehensive Eye Exam
During a comprehensive ophthalmologic examination, patients can expect to be in the office for approximately 1.5 hours. A medical history will be taken, followed by a measurement of your vision. If you wear glasses or contact lenses, it is important for you to bring these with you. If you are able, please visit our secure Patient Portal prior to your visit in order to complete your ocular and medical history forms.
A sequence of tests to determine the health of your eyes will be performed. Many general medical conditions and even certain medications can generate abnormal findings on an eye exam. Your eyes will be dilated, so expect increased light sensitivity and blurred vision for a few hours following the exam. Most patients are still capable of driving after the exam, but, if you have concerns, it is important that you make arrangements in advance.
Patients who are seen for surgical consultations will require additional testing and counseling, so the process is somewhat lengthier. We strive to do our best to be efficient, but thoroughness is our most important goal.
Many medical insurance plans cover comprehensive ophthalmology examinations. Our office staff will be glad to help guide you through this process.
Approximately 16 million Americans have diabetes. Each year, 12,000 to 24,000 people lose their sight because of diabetes.
Diabetic eye disease includes diabetic retinopathy, cataracts and glaucoma. Diabetic retinopathy is the leading cause of new cases of blindness among working age people in the United States. In diabetic retinopathy, leakage and hemorrhage occur in the retina (the back of the eye) leading to the loss of vision.
Laser treatment and/or the administration of special medications (anti-vascular endothelial growth factor, or “anti-VEGF” medicines) that effect the quality of small blood vessels at the appropriate time can prevent bleeding within the eye and vision loss from macular edema (swelling in the 20/20 spot of the retina). Additionally, people with diabetes are more likely to get cataracts at a younger age and are twice as likely to develop glaucoma.
It is essential that anyone with diabetes have an annual eye exam by an ophthalmologist who is trained to diagnose and treat diabetic retinopathy.
Conditions which alter the normally smooth contour of the cornea or lead to clouding of the normally crystal clear cornea, can lead to vision loss. When the vision loss is severe, a corneal transplant may become necessary. These conditions include, but are not limited to, trauma, infections of the cornea, keratoconus, Fuch’s Dystrophy, and chemical injury.
Corneal transplant surgery involves removing the patient’s damaged cornea and replacing it with a clear donor cornea. The procedure takes approximately one hour to perform and is normally done on an outpatient basis (you can go home the same day). Corneal transplants are the most successful type of transplant in the body with success rates from 85-95%. Like most eye surgeries, corneal transplants are performed under an operating microscope which magnifies the eye 30 to 60 times. Serious complications are uncommon but include graft rejection, infection, and bleeding in the eye.
While most patients are able to care for themselves within one to two days after surgery, it is important to refrain from heavy lifting or swimming for three to four weeks following a corneal transplant The recovery of clear vision often takes several months for a full-thickness corneal transplant. Glasses or contact lenses may be needed to achieve functional vision. Additionally, refractive procedures such as LASIK may be performed once the corneal transplant has healed.
For certain ocular conditions that result in permanent corneal edema (swelling), newer tissue sparing transplant methods (such as DSEK — Descemet’s Stripping with Endothelial Keratoplasty orDMEK – Descemet’s Membrane Endothelial Keratoplasty) enable patients to achieve a more rapid visual recovery. Because the vast majority of the patient’s cornea is left intact, the eye is stronger and more resistant to injury than with traditional corneal transplants, and most suture-related complications can be avoided. Some patients with corneal scarring or warpage that spares the patient’s own corneal endothelial cells (innermost layer of the cornea), a partial thickness corneal transplant of the front layer of the cornea (Deep Anterior Lamellar Keratoplasty – DALK) can be considered.
Dry Eye Treatment
Dry eye syndrome is one of the most common problems treated by eye physicians. Over ten million Americans suffer from dry eyes. It is usually caused by a problem with the quality of the tear film that lubricates the eyes.
Tears are comprised of three layers. The mucus layer coats the cornea, the eye’s clear outer window, forming a foundation so the tear film can adhere to the eye. The middle aqueous layer provides moisture and supplies oxygen and other important nutrients to the cornea. This layer is made of 98 percent water along with small amounts of salt, proteins and other compounds. The outer lipid layer is an oily film that seals the tear film on the eye and helps to prevent evaporation.
Tears are formed in several glands around the eye. The water layer is produced in the lacrimal gland, located under the upper eyelid. Several smaller glands in the lids make the oil and mucus layers. With each blink, the eyelids spread the tears over the eye. Excess tears flow into two tiny drainage ducts in the corner of the eye by the nose. These ducts lead to tiny canals that connect to the nasal passage. The connection between the tear ducts and the nasal passage is the reason that crying causes a runny nose.
In addition to lubricating the eye, tears are also produced as a reflex response to outside stimuli such as an injury or emotion. However, reflex tears do little to soothe a dry eye, which is why someone with watery eyes may still complain of irritation.
Dry eye syndrome has many causes. One of the most common reasons for dryness is simply the normal aging process. As we grow older, our bodies produce less oil – 60% less at age 65 than at age 18. The effect is more pronounced in women, who tend to have drier skin than men. The oil deficiency also affects the tear film. Without as much oil to seal the watery layer, the tear film evaporates much faster, leaving dry areas on the cornea.
Many other factors, such as hot, dry or windy climates, high altitudes, air-conditioning, and cigarette smoke also cause dry eyes. Many people also find their eyes become irritated when reading or working on a computer. Stopping periodically to rest and blink can help keep the eyes more comfortable.
Contact lens wearers may also suffer from dryness because the contacts absorb the tear film, causing proteins to form on the surface of the contact lens. Certain medications, thyroid conditions, vitamin A deficiency, and diseases such as Parkinson’s and Sjogren’s can also cause dryness. Women frequently experience problems with dry eyes as they enter menopause because of hormonal changes.
- Blurred vision that improves with blinking
- Excessive tearing
- Increased discomfort after periods of reading, watching TV, or working on a computer
Dry eye treatment usually begins with lubricating the surface of the eye. Eyedrops known as Artificial Tears are easy to find in any pharmacy. They come in different thicknesses/consistencies, so you may have to experiment to find the one that works best for you. Some drops contain preservatives that might irritate your eyes. Drops without preservatives don’t usually bother the eyes but may be less convenient to use.
At night, an eye ointment might provide more relief than artificial tears alone. Ointments are thicker than artificial tears and can moisturize and protect the eye for several hours. Once applied, they may blur your vision, which is why some people prefer to use lubrivant ointments only while they sleep.
Another alternative is to have a minor procedure to close the tear ducts that drain tears from the eye. The procedure is called punctal occlusion. For a temporary closure, the eye doctor inserts dissolvable (often made of Collagen) plugs into the ducts. Collagen plugs eventually dissolve, and silicone plugs are “permanent” until they are removed or fall out. For a longer lasting effect, the eye doctor can use a laser or cautery to seal the ducts.
Some patients benefit from an eyedrop medication (prescription required) called Restasis. When effective, Restasis promotes tear production and improves the protective quality of the tear film. Additionally, there is evidence that taking omega-3-fatty acids (ie: flaxseed oil) can improve dry eye symptoms. Maintaining good eyelid hygiene using warm compresses/gentle lid scrubs is important in order to make sure that the oily component of the tear film is optimized. Dermatologic conditions such as Rosacea can make it exacerbate dry eye symptoms because its effect on patients’ eyelids. Oral medications such as Doxycline can be helpful for improving tear film health.
For patients contemplating vision correction surgery (ie: LASIK, Cataract Surgery with Lens Implants), it is important to have the surface of the eye (cornea) as unaffected by Dry Eye Syndrome as possible. If you are currently bothered by dry eye symptoms, please contact our office to arrange a consultation.