Vittone Eye Associates FAQs

 

If you don't understand your eye care professional's responses, ask questions until you do understand. Take notes or get a friend or family member to take notes for you or bring a tape recorder to help you remember the discussion. Ask your eye care professional to write down his or her instructions to you. Ask your eye care professional for printed material about your condition and if you still have trouble understanding your eye care professional's answers, ask where you can go for more information. Other members of your health care team, such as nurses and pharmacists, can be good sources of information. Talk to them, too. Today patients take an active role in their health care. Be an active patient about your eye care.

What are some questions to ask?

About my eye disease or disorder…

What is my diagnosis?

What caused my condition?

Can my condition be treated?

How will this condition affect my vision now and in the future?

Should I watch for any particular symptoms and notify you if they  
          occur?

Should I make any lifestyle changes?

About my treatment…

What treatment for my condition?

When will the treatment start and how long will it last?

What are the benefits of this treatment and how successful is it?

What are the risks and side effects associated with this treatment?

Are there foods, drugs or activities I should avoid while I'm on this
          treatment?

If my treatment includes taking medicine, what should I do if I miss a
          dose?

Are other treatments available?

About my tests…

What kinds of tests will I have?

What can I expect to find out from these tests?

When will I know the results?

Do I have to do anything special to prepare for any of the tests?

Do these tests have any side effects or risks?

Will I need more tests later?

 

Specific Questions:

What can I do to protect my vision?

Wearing sunglasses and a hat with a brim to block ultraviolet sunlight may help to delay cataracts. If you smoke, stop. Researchers also believe good nutrition can help reduce the risk of age-related cataract. They recommend eating green leafy vegetables, fruit and other foods with antioxidants.

If you are age 60 or older, you should have a comprehensive dilated eye exam at least once every two years. In addition to cataracts, your eye care professional can check for signs of age-related macular degeneration, glaucoma and other vision disorders. Early treatment for many eye diseases may save your sight.

 

Q. What is a cataract?

         A cataract is a clouding of the lens in the eye that affects vision. Most

         cataracts are related to aging.  Cataracts are very common in older

         By age 80, more than half of all Americans either have a cataract or     

         have had cataract surgery.  A cataract can occue in either or both    

         eyes.  It cannot spread from one eye to the other.

 

Q: How is a cataract detected?

Cataract is detected through a comprehensive eye exam that includes:

• Visual acuity test: This eye chart test measures how well you see at various distances.

• Dilated eye exam: Drops are placed in your eyes to widen or dilate the pupils. Your eye care professional uses a special magnifying lens to examine your retina and optic nerve for signs of damage and other eye problems. After the exam, your close-up vision may remain blurred for several hours.

• Q: Are there other types of cataracts?

Yes. Although most cataracts are related to aging, there are other 
          types of cataracts:

• Secondary cataract: Cataracts can form after surgery for other eye problems, such as glaucoma. Cataracts also can develop in people who have other health problems, such as diabetes. Cataracts are sometimes linked to steroid use.

•  

• Traumatic cataract: Cataracts can develop after an eye injury, sometimes years later.

• Congenital cataract: Some babies are born with cataracts or develop them in childhood, often in both eyes. These cataracts may be so small that they do not affect vision. If they do, the lenses may need to be removed.

• Radiation cataract: Cataracts can develop after exposure to some types of radiation.

Q: What are the symptoms of a cataract?

The most common symptoms of a cataract are:

• Cloudy or blurry vision.

• Colors seem faded.

• Glare. Headlights, lamps or sunlight may appear too bright. A halo may appear around lights.

• Poor night vision.

• Double vision or multiple images in one eye. (This symptom may clear as the cataract gets larger.)

• Frequent prescription changes in your eyeglasses or contact lenses.

These symptoms also can be a sign of other eye problems. If you have any of these symptoms, check with your eye care professional.

Q: Who is at risk for cataracts?

The risk of cataract increases as you get older. Other risk factors for
          cataract include:

• Certain diseases (for example, diabetes).

• Personal behavior (smoking, alcohol use).

• The environment (prolonged exposure to ultraviolet sunlight).

 

Q: How is a cataract treated?

Surgically

 

Surgery involves removing the cloudy lens and replacing it with an artificial lens. A cataract needs to be removed when vision loss interferes with your everyday activities, such as driving, reading or watching TV. You and your eye care professional can make this decision together. Once you understand the benefits and risks of surgery, you can make an informed decision about whether cataract surgery is right for you. Sometimes a cataract should be removed even if it does not cause problems with your vision. For example, a cataract should be removed if it prevents examination or treatment of another eye problem, such as age-related macular degeneration or diabetic retinopathy. I If you have cataracts in both eyes that require surgery, the surgery will be performed on each eye at separate times, usually four to eight weeks apart.

 

Q: What happens before surgery?

Before surgery, your doctor will do some tests. These tests may include measuring the curve of the cornea and the size and shape of your eye. This information helps your doctor choose the right type of IOL. You may be asked not to eat or drink anything 12 hours before your surgery.

Q: What if I have other eye conditions and need cataract surgery?

Many people who need cataract surgery also have other eye conditions, such as age-related macular degeneration or glaucoma. If you have other eye conditions in addition to cataracts, talk with your doctor. Learn about the risks, benefits, alternatives and expected results of cataract surgery.

 

Q: Are there different types of cataract surgery?

There are two types of cataract surgery. Your doctor can explain the differences and help determine which is better for you.

• Phacoemulsification, (or phaco) - A small incision is made on the side of the cornea, the clear, dome-shaped surface that covers the front of the eye. Your doctor inserts a tiny probe into the eye. This device emits ultrasound waves that soften and break up the lens so that it can be removed by suction. Most cataract surgery today is done by phacoemulsification, also called "small incision cataract surgery."

• Extracapsular surgery - Your doctor makes a longer incision on the side of the cornea and removes the cloudy core of the lens in one piece. The rest of the lens is removed by suction. After the natural lens has been removed, it is often replaced by an artificial lens, called an intraocular lens (IOL). An IOL is a clear, plastic lens that requires no care and becomes a permanent part of your eye. Light is focused clearly by the IOL onto the retina, improving your vision. You will not feel or see the new lens. Some people cannot have an IOL. They may have another eye disease or have problems during surgery. For these patients, a soft contact lens or glasses that provide high magnification may be suggested.

 

Q: Is cataract surgery effective?

Cataract removal is one of the most common operations performed in the United States. It also is one of the safest and most effective types of surgery. In about 95% of cases, people who have cataract surgery have better vision afterward.

 

Q: What happens during surgery?

At the hospital or eye clinic, drops will be put into your eye to dilate the pupil. The area around your eye will be washed and cleansed. The operation usually lasts less than twenty minutes and is almost painless. Many people choose to stay awake during surgery. Others may need to be put to sleep for a short time. If you are awake, you will have an anesthetic to numb the nerves in and around your eye. After the operation, a shield may be placed over your eye. You will rest for a while. Your medical team will watch for any problems, such as bleeding. Most people who have cataract surgery can go home the same day. You will need someone to drive you home.

 

Q: What happens after surgery?

Itching and mild discomfort are normal after cataract surgery. Some fluid discharge is also common. Your eye may be sensitive to light and touch. If you have discomfort, your doctor can suggest treatment. After one or two days, moderate discomfort should disappear. After surgery, your doctor may ask you to use eyedrops to help healing and decrease the risk of infection. Ask your doctor about how to use your eyedrops, how often to use them and what effects they can have. You will need to wear an eye shield or eyeglasses to help protect your eye. Avoid rubbing or pressing on your eye. When you are home, try not to bend from the waist to pick up objects on the floor. Do not lift any heavy objects. You can walk, climb stairs and do light household chores. In most cases, healing will be complete within eight weeks. Your doctor will schedule exams to check on your progress.

 

Q: What are the risks of cataract surgery?

As with any surgery, cataract surgery poses risks, such as infection and bleeding. After surgery, you must keep your eye clean, wash your hands before touching your eye, and use the prescribed medications to help minimize the risk of infection. Serious infection can result in loss of vision. Cataract surgery slightly increases your risk of retinal detachment. Other eye disorders, such as high myopia (nearsightedness), can further increase your risk of retinal detachment after cataract surgery. A retinal detachment is a medical emergency. If necessary, go to an emergency service or hospital. A retinal detachment causes no pain. Early treatment for retinal detachment often can prevent permanent loss of vision.

 

Q: When will my vision be normal again after cataract surgery?

You can quickly return to many everyday activities, but your vision may be blurry. The healing eye needs time to adjust so that it can focus properly with the other eye, especially if the other eye has a cataract. Ask your doctor when you can resume driving. If you received an IOL, you may notice that colors are very bright. The IOL is clear, unlike your natural lens that may have had a yellowish/brownish tint. Within a few months after receiving an IOL, you will become used to improved color vision. Also when your eye heals, you may need new glasses or contact lenses.

Q: Can problems develop after surgery?

Problems after surgery are rare, but they can occur. These problems 
          can include:

infection, bleeding, inflammation (pain, redness, swelling), loss of vision, double vision and high or low eye pressure. Sometimes the eye tissue that encloses the IOL becomes cloudy and may blur your vision. This condition is called an after-cataract. An after-cataract can develop months or years after cataract surgery. An after-cataract is treated with a laser. Your doctor uses a laser to make a tiny hole in the eye tissue behind the lens to let light pass through. This outpatient procedure is called a YAG laser capsulotomy. It is painless and rarely results in increased eye pressure or other eye problems. As a precaution, your doctor may give you eyedrops to lower your eye pressure before or after the procedure.

Q: What is diabetic retinopathy?

Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina, the light-sensitive tissue at the back of the eye. A healthy retina is necessary for good vision. If you have diabetic retinopathy, you may notice no changes to your vision at first. But over time, diabetic retinopathy can get worse and cause vision loss. Diabetic retinopathy usually affects both eyes.

Q: What is glaucoma?

Glaucoma is a disease that can damage the eye's optic nerve and result in vision loss and blindness. It is related to the eye pressure. However, with early treatment, you can often protect your eyes against serious vision loss.

Q.  How is glaucoma treated?

          Usually with eye drops.  There are also other laser treatments available

             for specific types of glaucoma.

Q:  What is Aged Macular Degeneration?

      AMD is a chronic condition that causes central vision loss.

      AMD occurs when the macula--the part of the retina that lets you see

      color and fine detail--becomes damaged.  AMD is a major cause of central

      vision loss in Americans aged 55 and older, effecting more than a million

      men and women.

 

Q:  What are the two forms of AMD?

     Dry - Dry AMD is more common than wet AMD, affecting more than 85%

     of AMD patients.  Because dry AMD usually develops slowly over time, and

     it may advance to wet AMD, it is important to carefully monitor your eyes.

 

    Wet - Wet AMD is the most serious form of AMD and it can progress very

    quickly.  Although only 10% of people with dry AMD will get wet AMD, it is

    a major cause of central vision loss in Americans aged 55 and older.

    About 200,000 people are diagnosed each year.  Wet AMD occurs with the

    abnormal growth of blood vessels in the back of the eye.  As the blood

    vessels grow, they can leak blood and fluid, which damage the macula.

    This leakage may result in the loss of your central vision.

 

Q: How can you monitor your vision for AMD?

    Ask your Doctor to monitor your vision with an Amsler grid.

 

Q: Is there any treatment for WET AMD?

    Yes...Lucentis and Avastin are breakthrough treatments for wet AMD.         

    With Lucentis / Avastin you may see your vision improve or keep the     

    vision you have.

    Some patients see results after their first few injections.  Everyone is

    different and individual results may vary.

   

Q: What is LASIK?

The name "LASIK" is short for Laser In-situ Keratomileusis. Like Photorefractive Keratectomy, which utilizes the Excimer Laser, LASIK reshapes the cornea with laser technology. The shape of the cornea is what determines whether you are nearsighted, farsighted, have astigmatism or have normal vision. The Excimer Laser emits a "cool" laser light that can remove microscopic amounts of tissue with extreme precision. Physicians can program the laser to sculpt the corneas.

 

A pioneer in the field of refractive surgery -- Dr. Daniel C. Vittone performed the first Radial Keratotomy (RK) procedure in Westmoreland County in 1992. As technology advanced, Dr. Vittone's refractive skills evolved. He introduced laser refractive surgery to Westmoreland, Cambria and Somerset Counties in 1995, after the FDA approved the VISX Excimer Laser. Since that time, Dr. Vittone has performed over 30,000 refractive procedures utilizing the excimer laser, making him one of the most experienced refractive surgeons in Western Pennsylvania.

Dr. Vittone is now proud to offer the recently approved CustomVue, providing personalized treatments to qualifying patients. At

Vittone Eye Associates, we are committed to helping you decide whether LASIK is right for you. Our network of ophthalmologists, optometrists and technicians is available and anxious to answer your questions as you consider the procedure. Contact us for more information.

Q: Am I a candidate?

To determine whether LASIK is right for you, you should undergo an evaluation with your eye care professional. The evaluation can confirm that your degree of myopia, hyperopia or astigmatism is within the proper range, make sure that your are currently free of any eye disease and discuss other details of both your case and the LASIK procedure. At the time of the evaluation, you should bring your glasses or contacts with you.

Q: When is LASIK not for me?

 

         Cost is an issue. Most medical insurance will not pay for refractive    

         surgery. 

    You have a disease or are on medications that may affect wound

    healing. Certain conditions, such as autoimmune diseases (e.g.lupus, 

    rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes,

    and some medications (e.g., retinoic acid and steroids) may prevent

    proper healing after a refractive procedure.

•  You are not an adult. Currently, no lasers are approved for LASIK on persons under the age of 18.

Precautions:

The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Discuss with your doctor if you have a history of any of the following:

• Herpes simplex or Herpes zoster (shingles) involving the eye area

• Glaucoma, glaucoma suspect or ocular hypertension

• Eye diseases, such as uveitis/iritis (inflammations of the eye)

• Eye injuries or previous eye surgeries

• Keratoconus

Other Risk Factors:

Your doctor should screen you for the following conditions or indicators
          of risk:

• Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin may result in blinding complications.

• Previous refractive surgery (e.g., RK, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.

• Q: Does my medical insurance pay for LASIK?

Probably not! At this time, most insurance companies consider LASIK surgery as a cosmetic surgical procedure. There are a few employers who have put special riders on their company's insurance policy to cover this procedure. Our staff will be glad to investigate if your insurance policy will cover LASIK.

Q: Are the results of LASIK permanent?

YES! Once your vision has been fully corrected the results are permanent. It is still possible to develop other medical conditions as you age that would change your vision.

Q: What should I expect before, during and after surgery?

What to expect before, during and after surgery will vary from doctor to doctor and patient to patient. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but it cannot replace the dialogue you should have with your doctor. Read this information carefully and discuss your expectations with your doctor.

Before Surgery:

If you decide to go ahead with LASIK surgery, you will need an initial or baseline evaluation by your eye doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect:

If you wear contact lenses, it's a good idea to stop wearing them before your baseline evaluation and switcit is h to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These

consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses.

If you wear:

• Soft contact lenses and toric soft lenses, you should stop wearing them for 1 week before your initial evaluation.

• Rigid gas permeable (RGP) lenses and hard lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.

You should tell your doctor:

• About your past and present medical and eye conditions.

• About all the medications you are taking, including over-the-counter. medications and any medications you may be allergic to.

Your doctor should perform a thorough eye exam and discuss:

• Whether you are a good candidate.

• What the risks, benefits and alternatives of the surgery are.

• What you should expect before, during and after surgery.

• What your responsibilities will be before, during and after surgery.

You should have the opportunity to ask your doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form. You should not feel pressured by your doctor, family, friends or anyone else to make a decision about having surgery. Carefully consider the pros and cons.

The day before surgery, you should stop using:

• Creams

• Lotions

• Makeup

• Perfumes

These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes. Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, make sure someone can bring you home after surgery. The surgery should take less than 15 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system.

 

The laser system includes a large machine with a microscope attached to it and a computer screen. A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open. A ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to cut a flap in your cornea.

 

The microkeratome and the suction ring are then removed. You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue. The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on.

NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery. When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser energy delivered to your eye. Before the start of surgery, your doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position. A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

Immediately after the procedure, your eye may burn, itch or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don't! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery.

You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better. You should see your doctor within the first 24 to 48 hours after surgery and at regular intervals after that for at least the first six months.

At the first postoperative visit, your doctor will remove the eye shield, test your vision and examine your eye. Your doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following surgery before beginning any non-contact sports, depending on the amount of activity required, how you feel and your doctor's instructions. To help prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise before using lotions, creams or make-up around the eye. Your doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery.

You should also avoid swimming and using hot tubs or whirlpools for 2 weeks. Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after surgery, your vision may fluctuate.

• It may take up to three to six months for your vision to stabilize after surgery.

• Glare, haloes, difficulty driving at night and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.

•  

• It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.

•  

• It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery. Contact your eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.

Q: What are the risks of LASIK?

Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That's why it is important for you to understand the limitations and possible complications of refractive surgery. Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.

• You may be under treated or over treated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you may still need reading glasses after surgery.

• Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. Dry eye not only causes discomfort, but can reduce visual quality due to intermittent blurring and other visual symptoms. This condition may be permanent. Intensive drop therapy and use of plugs or other procedures may be required.

• Results are generally not as good in patients with very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.

• For some farsighted patients, results may diminish with age. If you are farsighted, the level of improved vision you experience after surgery may decrease with age. This can occur if your manifest refraction (a vision exam with lenses before dilating drops) is very different from your cycloplegic refraction (a vision exam with lenses after dilating drops).

• Q: If I am not a candidate for LASIK, are there any other options?

YES! Other options are available. Patients not eligible for LASIK can explore other procedures available to correct their nearsightedness, farsightedness and/or astigmatism. You can discuss these options with your doctor. 

Q: What is VISX CustomVue?

VISX CustomVue is an individual laser vision correction procedure that is WaveScan driven. This enables the doctor to measure and correct unique imperfections in each individual's vision. Many of these imperfections could never be measured before by standard methods used for glasses and contact lenses.