Your eyes are your window to the world, so it’s important to take good care of them. Preventive measures like wearing sunglasses, not smoking cigarettes and eating a healthy diet can reduce your risk for some problems, like cataracts. It’s also important to get regular vision screenings. New technological and surgical advances, including refined lasers, incisionless surgery and better lens implants, are helping millions of people see better.
[lasik]
Local experts say there’s never been a better time to choose LASIK corrective eye surgery, thanks to advances in technology and more experienced surgeons.
Dr. Stephen A. Wexler, Eye Care Associates of St. Louis:
The laser technology used in LASIK has become better each year. We now use two lasers to complete a LASIK procedure—one to make the corneal flap and one to correct the eye’s prescription. Today’s bladeless LASIK procedure is also significantly safer than the older procedure, in which we used an instrument called a microkeratome to make the LASIK flap. Moreover, we have become much more sophisticated in determining which individuals make the best LASIK candidates and which are at higher risk for problems and should avoid the procedure.
Time has shown that LASIK results are generally long-lasting. We have tracked outcomes for many years, and outcomes have become more accurate as laser technology has improved. Every week, I see individuals who had LASIK more than 10 years ago and are still enjoying great distance vision. Of course, LASIK does not correct near vision, and people often need reading glasses more as they age.
Modern bladeless LASIK surgery is life-changing for so many people. Do your homework and find an experienced provider who uses the most modern equipment.
Dr. Sean P. Mulqueeny, Mulqueeny Eye Centers:
LASIK has gone through transformative advances in the last decade. We now use super-fast lasers that improve our ability to precisely treat a patient’s eyes. In addition, the size of the laser beam is a fraction of the size originally used. This allows for a finer, smoother ablation or treatment. We use the state-of-the-art Allegretto laser, which incorporates the latest technologies.
Many patients who were not previously candidates for LASIK now qualify, thanks to technological advances. And for patients who still do not qualify for LASIK, there are other options, such as implantable contact lenses.
Today’s LASIK procedures offer extremely high success rates. A big part of that success, however, hinges on carefully choosing the correct procedure. We take the time to give patients a clear explanation of their options, risks and benefits, to ensure that each patient is comfortable with their surgical choice.
The future for LASIK is very exciting. There’s work being done on what’s called a topographically driven laser, which should further refine results and make the surgery even more predictable.
[cataracts]
Cataracts are the leading cause of blindness worldwide, but they’re fully treatable with surgery.
Dr. Gregory A. Hill, Hill Vision Services:
Cataracts are a clouding of the natural lens that prevents light from passing through to the back of the eye. They are very common as the population ages. Early symptoms include declining vision, particularly night vision; difficulty reading fine print; needing more light to see; and problems with glare, particularly during nighttime driving or on a sunny day, that can cause vision to diminish significantly. For many patients, the symptoms come on so gradually that they do not notice their declining vision until it is significantly affected.
If you notice changes in your eyesight, it’s very important that you see a doctor and are screened for cataracts, macular degeneration and other vision problems. Cataracts are treated surgically through a relatively short, out-patient procedure. Using ultrasound power, sometimes assisted by a laser, we break up the lens and aspirate it out through a tiny incision. Then we replace it with an artificial lens to restore vision. The surgery success rate is extraordinarily high, and cataract surgery can greatly improve your quality of life.
Dr. Sean Edelstein, SLUCare:
By age 80, more than half of all Americans either have a cataract or have had cataract surgery. Advanced age is the most common cause for cataract formation. Cigarette smoking has been shown to increase the rate of cataract formation by up to three-fold. People with diabetes also are at greater risk. Other potential causes include blunt trauma to the eye; radiation, including ultraviolet-B light from the sun and excessive microwave and X-ray radiation exposure; and some medications, such as corticosteroids and antipsychotics.
Cataract surgery has evolved tremendously over the past two decades into a low-risk procedure yielding excellent results. Micro-incision, no-stitch surgery results in faster healing and better vision. The latest technological advances include the availability of laser-assisted cataract surgery, which is the use of a femtosecond laser to aid the surgeon in performing all the key steps involved in cataract surgery. This makes the surgery even more precise and safe. There is a wide selection of intraocular lenses available that can correct a full range of vision and high astigmatism.
[ptosis]
There are two main causes of upper eyelid droopiness: excess eyelid skin (dermatochalasis) and ptosis, induced by muscle weakness or paralysis.
Dr.John B. Holds, Ophthalmic Plastic & Cosmetic Surgery Inc.:
Ptosis, or blepharoptosis, is an abnormally low position of the upper eyelid margin. It can be inborn (congenital) or acquired. Abnormal appearance and visual obstruction are the most common effects. Congenital ptosis is somewhat uncommon: fewer than 1 in 5,000 people are born with severely drooping lids. With advanced age the prevalence of ptosis is approximately 10 percent, although many of these patients are not symptomatic or are never referred for treatment.
Ptosis may result from developing an abnormality in the elevating eyelid muscle or even in the brain. Most acquired ptosis is due to a defect in the tendon that elevates the eyelid (levator aponeurosis). In children, untreated ptosis may lead to developmental problems or a lazy eye. Even beginning to walk can be delayed due to an abnormal head posture. Various operations address the abnormal anatomy and correct the eyelid position to achieve a normal appearance and function.
Ptosis is treatable, but the surgery is exacting and requires a great deal of skill and experience to achieve adequate results.
Dr. Steven Couch, Washington University School of Medicine:
Age-related stretching of the tendon from the eyelid opening muscle (levator muscle) is the most common cause of ptosis. However, certain factors can exacerbate the condition, including contact lens use, trauma and previous ocular surgery. Occasionally, neurological conditions, including strokes and carotid dissection, or muscular diseases, including muscular dystrophy or myasthenia gravis, can propagate a droopy eyelid. It’s imperative to tease out the cause of droopy eyelids so proper treatment can be performed, not only to prevent complications, but also to effectively identify and treat the underlying issue that initiated the droop.
When most people refer to eyelid droop, they are speaking about dermatochalasis (excessive eyelid skin). These conditions are treated in different ways, with the excess skin removed through blepharoplasty. But ptosis is treated with precise surgery involving the tendon and muscle in the eyelid. Excessive heaviness in the eyebrows causing mechanical depression of the eyelid also can occur, but can be treated with brow-lifting surgery.
It’s important to have an experienced provider accurately diagnose the cause of eyelid droop, so precise surgical treatment can be planned for the best chance of a successful outcome.
[lens implants]
Our eyes work by focusing light onto the retina, just like the lens of a camera. “As we get into our mid-40s and older, the human lens first starts to harden and lose its near-focusing ability, and then it gradually clouds,” explains Dr. Jay S. Pepose, director of the Pepose Vision Center. Lens implants replace the cloudy lens with an artificial intraocular lens to refocus the light onto the retina, he explains.
Lens implants also sometimes are used in younger patients who don’t have cataracts but aren’t optimal candidates for LASIK surgery, due to severely dry eyes, thin corneas, extremely deep-set eyes or a very high prescription. “In these situations, it may be possible to insert a Visian lens implant, located just anterior to the natural lens of the eye, to accomplish a goal similar to that achieved with LASIK,” Pepose says.
Most patients have a stable refraction following cataract surgery, Pepose says. “With new lens implants that can address astigmatism and also give a more expanded range of intermediate and near vision, many patients find themselves far less dependent on glasses than they did prior to surgery,” he notes. “In some patients, the capsule that holds the lens implant can cloud over time. If so, we can treat it with a laser without returning to the operating room.”
[longer lashes]
“Eyelash enhancers are very different from Latisse, an FDA-approved medication that has proven efficacy and safety,” says SLUCare dermatologist Dr. Dee Anna Glaser. “Latisse actually helps your natural lashes grow longer, darker and thicker. It can help with people who just don’t have enough lashes, or whose lashes have thinned due to aging or chemotherapy.” According to Glaser, it takes about four months to get maximum benefit with Latisse, but most patients see improvement within four to eight weeks.
Over-the-counter lash enhancers, on the other hand, have not been studied extensively to prove efficacy or safety, Glaser notes. “They may contain ‘nutrients’ or vitamins, peptides, antioxidants, or other agents that make the lashes look fuller or darker or longer,” she says.
The most common side effects of Latisse are mild eye redness and itch. “Darkening of the skin of the eyelid-lash margin can occur, but most of my patients like this because it looks like eyeliner,” Glaser says. “The safety of over-the-counter enhancer products hasn’t been extensively studied, but generally they’re well-tolerated, though there may be some mild redness or itch as well.” Other options like false lashes and lash extensions can cause irritation, allergic reactions and eyelash loss, she adds.
Both Latisse and over-the-counter lash enhancers require regular use to maintain results, Glaser says. “And both products can be used in conjunction with mascara and other cosmetics.”
