A cataract is a cloudy area in the normally clear lens in front of the eye. The eye has a lens to focus visual images, just as a camera does. A young person's lens is typically clear. Cataracts are caused by a chemical change of unknown origin in the lens of the aging eye, and result in blurred or distorted vision. More than 50% of people over the age of 60 will have some degree of cataract. Younger people may have significant cataracts if they have diabetes, have sustained trauma to the eye, or have taken certain medications, such as prednisone. The cloudiness from a cataract is usually progressive but painless with increasing age. There are several symptoms that indicate failing vision from cataracts. These may include:

• Blurred/hazy vision
• Spots in front of the eye (s)
• Sensitivity to glare
• A feeling of "film" over the eye (s)
• A temporary improvement in near vision

Vision loss from a cataract can often be improved with a change in prescription glasses. If the cataract is more advanced, cataract surgery is needed. This is the most common surgical procedure done in this country. In this surgery, the cataract lens is removed and replaced with an artificial lens called an intraocular lens or IOL.

Cataract Surgery

Cataract surgery is an outpatient surgery that can be done at a hospital or in an ambulatory surgery center. Patients can typically return home within several hours. Mild sedation is given and the eye is numbed, either with eye drops alone or with an injection around the eye. A small incision of a few millimeters is made in the cornea, and an ultrasonic probe is inserted into the eye. The cataract is broken up by the ultrasonic waves and the small pieces are gently aspirated out through the probe. This is called phaco-emulsification. Lasers are not used to remove cataracts.

Phaco Surgery	IOL in place

A flexible folded IOL, is then inserted through the incision, and this unfolds into the space where the cataract was removed. The incision typically closes and heals without any stitches. The procedure usually takes 15-20 minutes, and often a shield and/or patch is applied to the eye until the next day. Most patients can resume their usual activities after 24 hours with some precautions regarding care of the eye for the next two weeks.

Upgrading Vision with Premium Cataract Implant Lenses/Accommodating and Presbyopia Correcting IOLs

Until recently, all cataract patients received monofocal lens implants during cataract surgery to provide clear distance vision again. After surgery, patients still had to use glasses to focus for reading and other close visual tasks. With new lens technology, patients can now choose to upgrade their lens implant to one which provides for both reading and distance vision without glasses. These new lenses allow most people to read newspapers, sew, cook, shop, use computers and drive without needing glasses. The following lenses are FDA approved for this purpose and are available through the Litscher Eye Center:

Crystalens®: "Auto-focusing" for far, near and everything in between.

The Crystalens® works like the eye's natural lens to allow patients to see images that are near (within one to two feet), intermediate (two to three feet), and distant without glasses. This auto-focus ability is powered by the same eye muscles that move and focus the eye's own natural lens prior to cataract development. This implant moves back and forth as the eye focuses at different distances, resulting in a seamless transition from far to arms'-length to near vision. A small percentage of people may still require glasses for reading fine print.

To learn more about Crystalens® go to http://www.Crystalens.com/

Dr. Litscher is among an elite group of 500 eye surgeons in the United States, and currently the only Springfield surgeon, to be certified in Crystalens® implantation.

ReSTOR® Lens: "Built-in bifocal"

The ReSTOR® lens is a non-moving implant. It is designed with an "apodized" diffractive surface, which appears as a series of very fine concentric ridges on the surface of the implant. This special surface allows both near and distant images to be focused simultaneously by the eye. The result is a gradual blending of focusing power through the lens surface. With this implant, people can see both distant objects (road signs) and near objects quite easily. Arms'-length vision, at two to three feet, may be less clear, and many people may need glasses for these types of tasks.

To learn more about AcroSof® ReSTOR® go to http://www.acrysofReStor.com/

The cornea has been called the "window of the eye." It is the thin, clear covering on the front of the eye which bends, or refracts, light waves that focus on the retina in the back of the eye. A certain shape or curvature is required in order for light to focus exactly on the retina, rather than in front of (nearsightedness) or behind it (farsightedness). An improperly curved cornea may be corrected surgically or non-surgically to reduce or eliminate the need for eyeglasses or contact lenses. A variety of conditions can cause the cornea to lose its natural clarity or proper shape and result in decreased vision. These conditions can be caused by injury, disease, or hereditary factors which lead to corneal swelling or scarring. When this occurs, the light entering the cornea is scattered or distorted, resulting in decreased vision. While some of these conditions can be overcome non-surgically, significant corneal damage may require a corneal transplant to replace the cornea with a healthy, clear cornea. A thorough eye examination and consultation with Dr. Litscher, a corneal specialist, is necessary before a treatment decision is made. He will clearly explain and discuss all treatment options. Common problems that could lead to transplantation include:

• Dry eyes
• Blepharitis
• Corneal ulceration
• Herpes simplex keratitis
• Pseudophakic corneal decompensation
• Keratoconus
• Corneal dystrophies
• Pterygium
• External tumors
• Traumatic injury
• Ocular surface diseases
• Chemical burns

Corneal transplantation (keratoplasty) is the most common and most successful of all organ transplants. It is a delicate microsurgical procedure which involves removing a disc-shaped portion of the damaged cornea. A healthy donor cornea obtained from the National Eye Bank is then stitched into place with very fine sutures. Local or general anesthesia is utilized, so the surgery is painless. It is usually done as an outpatient "day stay" procedure, as there is very little discomfort afterwards. The operation may take 45 to 90 minutes.

Dr. Litscher has specialized training in corneal diseases and surgery, and has extensive experience with this surgery. He has performed hundreds of corneal transplants over nearly 25 years.

 

Dry eye (keratitis sicca) is the term for eyes that are insufficiently moisturized, either because they do not produce enough tears or because the tears have an improper chemical composition. It often occurs during the natural aging process, but it can also develop as the result of eyelid or blinking problems, certain medications (antihistamines, oral contraceptives, antidepressants), climate (humidity, wind, dust), injury and various health problems (arthritis, Sjögren's syndrome).

In addition to being uncomfortable, dry eye can damage eye tissue, scar the cornea and impair vision. Dry eye is not preventable, but it can be controlled before harm is done to the eyes. Regular eye exams can detect dry eye early, even before symptoms become noticeable. Symptoms include:

• Irritated, scratchy, dry, uncomfortable or red eyes.
• A burning sensation or feeling of something foreign in the eye.
• Blurred vision.
• Excessive mucus or stickiness in the eyes.

Treatment for dry eye can take many forms. Non-surgical methods include increasing humidity at home or work and use of frequent artificial tear drops or lubricating ointments. Oral forms of vitamin C and flaxseed oil have also shown to be beneficial. A new medication called Restasis® is available as an eye drop to increase a person's own natural tear production. If these methods fail, small soft silicone plugs called punctal plugs may be inserted into the tear ducts in the corners of the eyes to limit their drainage. Alternatively, the opening of the tear ducts can be surgically closed. Both of these methods help to maintain more of the tear moisture on the surface of the eye.

Glaucoma is the condition that occurs when the pressure inside the eye rises high enough to damage the optic nerve. It is the leading cause of blindness and vision impairment in the United States. Glaucoma is more prevalent with increasing age, but it can occur at any age. It has been estimated that up to three million Americans have glaucoma; at least 50% of these people do not know they have it because glaucoma usually has no symptoms. That it is why it has been labeled the "sneak thief of sight."

Normal Vision	Glaucoma Vision

The increased pressure in the eye is from the fluid, called aqueous humor, which is inside of the eye. Normally, there is a balance between the amount of fluid being produced in the eye and the amount being continuously drained through micro-channels in the eye wall. In most cases, it is not known why the drainage channels develop increased resistance to this fluid drainage and allow the fluid pressure to increase in the eye. It is this increased pressure that damages the optic nerve and gradually destroys vision, usually starting with the peripheral (side) vision. If left untreated, glaucoma is gradually progressive and the vision loss will extend from the periphery towards the center. Vision loss from glaucoma is permanent; there is no way to restore the lost vision. In its advanced stage, only "tunnel vision" may remain, but total blindness can eventually occur.

Symptoms may occasionally be present and should be considered as warning signs. These include blurred vision, loss of peripheral vision, halos around lights, and painful or red eyes. People at greater risk include those who are over the age of 40, diabetic, nearsighted, African-American, or have a family history of glaucoma, or history of eye injury. With early diagnosis and treatment, vision is typically preserved. Dr. Litscher screens for glaucoma by measuring eye pressure and examining the optic nerve at every complete eye exam. Sometimes, an additional test called a visual field is also required.

There are four basic types of glaucoma:

• Open angle – the most prevalent kind of glaucoma, which does damage slowly and silently.
• Narrow or closed angle – this can be silent or can present as an acute attack, characterized by extreme eye pain, headache, and possibly vomiting.
• Secondary glaucoma – this develops after an eye injury, disease, or even after taking some medications.
• Congenital glaucoma – this rare problem can be present at birth and can put infants in danger of blindness even while they are still in the nursery.

Glaucoma usually requires monitoring and treatment for the patient's lifetime. Therapy is directed at lowering the eye pressure. Modern treatments are quite effective at halting the progression of glaucoma. Medicines are usually in the form of eye drops to be used once, twice or three times a day. If eye drops are not effective enough, a painless office treatment with a laser light, called trabeculoplasty, can successfully lower the pressure about 80% of the time. Some forms of glaucoma are resistant to these treatments, and surgery may need to be done. Trabeculectomy is a microsurgical procedure in which a small channel is made in the wall of the eye to allow an alternative drainage channel for the high pressure fluid within the eye.

Dr. Litscher can recommend the most appropriate treatment for glaucoma and monitor the effectiveness of any of these treatments.

Age-related macular degeneration (ARMD) is a disorder of the retina associated with loss of central vision. It is the most common cause of legal blindness in people over 60 years of age. There may be over 50 million people in the United States affected by this disease. The macula is a very small area in the center of the retina responsible for reading and detailed vision. An irreversible loss of central vision may occur when the retinal cells in this region undergo a "degeneration."

Macular degeneration is generally classified into a dry form and a wet form. The dry form is usually the less severe form and occurs in about 85% of all cases. There is no treatment available for this form of degeneration, although studies have shown some benefit to certain vitamin supplementation.

Wet macular degeneration represents about 15% of all cases and reflects abnormal blood vessel growth below the surface of the retina. These blood vessels grow abnormally into the space below the retina. They have a tendency to release fluid and blood. This can lead to scarring of the overlying retina and irreversible vision loss.

Dry degeneration can sometimes evolve into wet degeneration. This may be heralded by a sudden change in vision, which often includes distortion in the size and shape of objects or loss of vision. Progression of vision loss is usually more rapid in this wet form.

Early recognition plays a significant role in successful management of macular degeneration. The risk of macular degeneration is related to family history, nutritional habits and smoking. Certain vitamin supplements may retard the progression of macular degeneration. Cessation of smoking can also be helpful in preserving vision. The role of ultraviolet light is somewhat controversial in macular degeneration; however, limiting UV exposure is thought to diminish the risk as well.

Dr. Litscher does a thorough exam of the macula at every complete eye exam. If there are signs of macular degeneration, he will discuss this with you and make recommendations to minimize the risk of vision loss. He may also recommend referral to a retinal specialist who has access to more sophisticated examination and treatment techniques. Treatment modalities for wet macular degeneration include laser treatment and medications which are injected inside the eye over the macula. While the result of some of these treatments remains mixed, many people are helped by one or more of the available treatment modalities.

About 16 million people in the United States have diabetes. Diabetes is the leading cause of new blindness among adults – people with diabetes are 25 times more likely to become blind than people without diabetes. Diabetics are also more prone to develop cataracts and glaucoma. By detecting and treating diabetic eye disease early, people with diabetes can typically preserve good vision.

The most common eye problem from diabetes is diabetic retinopathy. In this condition, the small blood vessels in the retina become damaged over time from the high blood sugar. The risk of retinopathy increases with poor control of diabetes and the longer the duration of the diabetes. When retinopathy develops, there can be bleeding or fluid oozing from damaged vessels into the retina, and eventually scarring of the retina. This results in impaired vision. In its advanced form, blindness can ensue if retinopathy remains untreated.

Diabetic retinopathy is painless, and in its earliest stages, has no symptoms. Eye examinations aimed at early detection of these changes in the retina should be done annually in all diabetics. When retinopathy is detected and treated early, the risk of vision loss is very low. The risk of retinopathy can be minimized by following the prescribed diet and medications, by exercising regularly, by controlling blood pressure, and by maintaining the appropriate blood sugar level.

Current treatments for retinopathy include the application of laser spots to the retina (retinal photocoagulation), injection of medications into the eye over the retina, and surgical procedures. If there are indications that diabetic retinopathy needs to be treated, Dr. Litscher may refer patients to one of the retinal specialists practicing in Springfield, Massachusetts.

 

Regular, routine eye examinations are one’s best assurance for maintaining good eye health and good vision throughout life. During this eye examination, all the structures of the eye are checked for health and function, and eye problems may be detected and treated before they become significant. The main parts of the eye examination include:

• Vision testing – acuity, color vision, depth perception.
• Refraction – measurement of any lenses needed to optimize the vision.
• Eye pressure – to check for glaucoma.
• Slit lamp examination – special illuminated microscopic examination of the front surface, lens, and pupil space of the eye.
• Funduscopic examination – special illuminated instrument to visualize the inside of the eye (fundus), includes the optic nerve, retina, macula, and vitreous fluid.
• Motility – check on coordination of eye movements.

Other tests often used for specific indications include:

• Visual field.
• Pachymetry (corneal thickness).
• Ultrasound imaging.
• Eye photography.
• Corneal topography.
• Dry eye testing.

Some parts of the eye examination require dilation of the pupil with drops to allow a better view inside the eye. Certified ophthalmic assistants may do some of the testing, however, Dr. Litscher sees every patient and makes all treatment decisions with the patient.

The suggested guidelines for the frequency of these eye examinations are as follows:

• Ages 0-2: Eye screening at regular pediatric visits by pediatrician.
• Ages 3-5 Eye screening every one to two years at regular primary doctor visits.
• Ages 6-19: At least one examination by an Eye M.D., and as needed.
• Ages 20-29: Same as above.
• Ages 30-39: Two eye examinations during these years.
• Ages 40-65: Eye examination every two to four years.
• Ages 65 and over: Eye examination every one to two years.

These are the minimal, suggested frequencies for routine eye examinations. Dr. Litscher may recommend more frequent eye checkups if any eye conditions are present which would require closer followup and monitoring.