Tuesday, 29 December 2015
Glaucoma Progression

Health Day (5/9, Preidt) reported, "Researchers say they've pinpointed a number of factors that may be key to the progression of glaucoma," according to a paper published in the journal Archives of Ophthalmology. Analyzed data of 587 patients "concluded that key risk factors for glaucoma progression included a thinning of the cornea, loss of side vision and an intraocular pressure of 18 or higher."

Dr. Keg's Thoughts
The risk factors listed in this recent summary article have been known to us for quite some time. We perform eye-pressure checks 1-4 times per year depending on individual need. Visual fields (side vision test) need to be performed in all patients who have been diagnosed with glaucoma or have any suspicious findings that make them a glaucoma suspect. Corneal thinning is a measurement we obtain only once as generally the cornea will maintain a stable thickness over the years. Each of these tests is evaluated with other findings to make an accurate risk assessment for the individual. We specifically will note your optic nerve profile, your retinal nerve fiber layer thickness, and your family history.

For patients who have had higher eye-pressure readings, we can provide you with a statistical probability of developing glaucoma in the next five years. This is very helpful as we consider treatment options, which usually includes eye drops. In some cases no drops are needed and continued monitoring is the best medicine.

Posted on 12/29/2015 10:37 AM by Dr. Jeff Kegarise
Wednesday, 16 December 2015
Gonioscopy Used in Glaucoma
In earlier blogs, we talked about each of us having a normal intraocular pressure. The eyeball is a closed structure. with fluid constantly being produced and draining out. This fluid is produced in the middle of the eye and circulates through the pupil moving forward and out the edge of the eye in a structure called the angle. The angle is really the connection between the cornea and the iris. When we are evaluating your eye, we can estimate the angle but can't see it completely without a special lens called a gonioscopy lens.

If your intraocular pressure is high, you might be producing too much fluid or the fluid is not draining as quickly. Either way, fluid pressure inside the eye goes up. By using gonioscopy, we can evaluate how open the drain is, and whether there are any obstructions. The drain or trabecular meshwork is actually a Swiss-cheese-like structure with multiple holes of drainage for the fluid to percolate through. As we mature, the drainage angle becomes more narrow. This can cause the eye pressure to gradually increase and put us at higher risk for developing nerve changes or glaucoma. For glaucoma patients we check gonioscopy every two years at a minimum.

Posted on 12/16/2015 10:47 AM by Dr. Jeff Kegarise
Tuesday, 8 December 2015
Do I have to wear bi-focals? Part IV

In previous blogs I've talked about glasses and contact lens options to bi-focals.  Both provide the ability to see far away, at the computer, and up close while working or performing activities. Many patients say prefer to not wear glasses or contacts at all and ask about laser vision. Unfortunately, laser surgery doesn't provide vision for far away and up close for the 40+ crowd. 

Newer technology is being explored is to implant a very small optical disc within he front surface of the eye to divert certain rays to allow you to have good near vision.  A corneal implant, intracorneal rod, inlay, or whatever name they ultimately agree on is the next step to allow patients - even those who have had LASIK - to be able to see at distance and at near without needing reading glasses. These are only in study phases nationally at this time. But it probably won't be long before we're offering this as an alternative for those patients who say, "I see well far away yet I have to wear bifocals," and want a surgical alternative. There are post-LASIK surgery options for improving near vision.  Our recommendation is that most people should wait as technology and research develops further before pursuing these surgical options.

Posted on 12/08/2015 2:44 PM by Dr. Jeff Kegarise
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