Service At Cornea Consultants

At Cornea Consultants in Tysons Corner, Virgina in addition to providing LASIK in Virgina, we offer examination, consultation and treatment for many common eye disorders. These include:

Macular Degeneration

The macula is the tiny central part of the retina which is responsible for fine detail vision and for color perception. Macular degeneration is a disease of this very important portion of the retina. It usually affects both eyes, but often begins in one eye.

In many cases, patients are not aware of macular degeneration in one eye, because the other eye compensates for the weaker one. The most common symptoms include difficulty reading, seeing up close or distorted lines. It occurs most often in people over fifty years of age. If you notice a dimness of vision in one or both eyes or if straight lines appear distorted, you should see an eye doctor immediately. There is no cure for macular degeneration, but recent research suggests that certain vitamins and nutrients may slow the progress of the disease in certain patients. If the disease is advancing, laser surgery can also be used to slow the disease.

If you are over fifty, have your eyes examined regularly. If you have symptoms, report them to your eye doctor immediately before the disease progresses too far.

Optic Neuritis

The retina lies in the back of the eye and is a multi-layered tissue which detects visual images. These images are transmitted to the brain through approximately 1 million tiny nerve fibers. These nerve fibers converge in the back of the eye, before going to the brain, into a bundle called the optic nerve. If some or all of the nerve fibers are damaged, visual capability deteriorates.

When the optic nerve becomes inflamed, this condition is called optic neuritis. The nerve tissue becomes swollen and red, and the nerve fibers do not work properly. If many of the nerve fibers are involved, the vision may be dramatically affected, but if the optic neuritis is mild, vision is nearly normal. Optic neuritis can be caused by many diseases and conditions and may affect the optic nerve of one or both eyes.

Some people, especially children, develop optic neuritis following a virus illness such as mumps, measles, or a cold. In others, optic neuritis may occur as a sign of a neurologic disease affecting nerves in various parts of the body, such as multiple sclerosis. In a rare condition called Leber's optic neuropathy, which often runs in families, a special kind of optic neuritis may appear in both eyes within a short span of time. Most of the time, however, the cause for optic neuritis is unknown. In those cases, the eye disorder is called neuritis idiopathic, meaning that no particular cause can be found.

Optic neuritis usually comes on suddenly, and the patient notices vision is blurred in one or both eyes. The vision is dim, like somebody turned down the lights, and colors may appear to be washed out. There may be pain in the area of the eye socket, especially when moving the eyes. The vision may continue to worse after exercising or a hot bath.

A careful description of these symptoms is important to your doctor for the diagnosis of optic neuritis. The optic nerve enters the back of the eye where it appears as a small disc. Your eye doctor can examine the optic nerve inside the eye by using a special instrument called an ophthalmoscope. Swelling of the optic nerve may or may not be visible. If the optic nerve inflammation occurs inside the eye, it can be readily detected. If swelling of the nerve occurs behind the eye, the doctor may not be able to see the swollen nerve tissue.

Since optic neuritis can be confused with many other causes of poor vision, an accurate medical diagnosis is important. Ultrasound, CT scans or visual brain wave recordings might be ordered. Other tests which may be performed include color vision, side vision, and pupil reactions to light.

At this time, there is no good treatment for optic neuritis. Cortisone-like medications (steroids) can be prescribed, but in most cases they are not effective. In many cases, patients with optic neuritis improve without treatment. The vision may return to normal or, in some cases, good but incomplete improvement occurs. A few patients fail to recover normal vision, especially those with special conditions.

Flashes and Floaters

The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits these to the brain. In front of the retina lies the vitreous humor. The vitreous is the jelly-like material that fills the large central cavity of the eye. It is composed primarily of water, but it is also made up of proteins and other substances which are more fibrous. The water and fibrous elements together give the vitreous the consistency of gelatin.

The vitreous is normally connected to the retina. During aging, the watery portion of the vitreous separates from the fibrous portions. As this occurs, the fibrous elements contract and can pull the vitreous away from the retina. This is called a Posterior Vitreous Detachment. This contraction on the retina is responsible for the characteristic "flashes" that often accompany the Posterior Vitreous Detachment. The "floaters" are frequently caused by the fibrous elements changing position during the Posterior Vitreous Detachment. They can also be caused by pieces of the retina being dislodged as the vitreous contracts. Besides aging, flashes and floaters are also associated with nearsightedness and injuries to the eye.

All patients who experience a recent onset of flashes and floaters should be examined immediately by their eye doctor. Most of the time nothing unusual is found, and simple reassurance is all that is needed. The flashes eventually go away, and the floaters diminish and become less bothersome with time.

In about 10% of the patients with a Posterior Vitreous Detachment, a tear of the retina is found. If left untreated, these tears may lead to a full retinal detachment. A full retinal detachment is a very serious sight threatening condition requiring a major surgical procedure to repair. When symptoms appear, it is important to examine the eye within a day of their onset. Changes can occur rapidly, and time can be of the essence if a retinal detachment is present.

Retinal tears are treated by sealing the tear with a laser or freezing technique (cryotherapy). Some are also treated with a surgical technique called a scleral buckle.

Dry Eyes

The eye has a tear film which coats the outer layer of the eye. This tear film is very important for the lubrication and comfort of the eye as well as for the clarity of vision. As we age, this protective tear film diminishes, and leaves the eye more exposed to the drying effects of the air, wind and dust. In many people the dryness is worse in the afternoon and evening.

Dry eye is not caused by a lack of tear production. In fact, during dry eye, the eye can still make so many tears that many patients complain of wet eyes and tearing with this malady. That's because the dryness causes the eye to produce more tears in an effort to replace the tear film. Dry eye is probably the most common problem seen in the eye doctor's office.

Dry eye symptoms include burning, stinging or a gritty sensation which may come and go depending on many factors. Itching, tearing and light sensitivity may also occur. Occasionally long strings of mucus can be stretched from a dry eye.

Blinking is very important for the maintenance of the tear film. When performing such activities as reading or working on a computer, we blink less frequently. This aggravates the symptoms of dry eyes. Sometimes environmental factors can also aggravate dry eye symptoms. Dry weather, either in hot or cold temperatures, robs the eye of needed lubricants. Cigarette smoke, fumes, dust and airborne particles are common irritants. In most patients, this condition is not associated with systemic disease.

Treatment helps in most patients. We cannot cure this condition, so treatment is an ongoing project. Usually artificial tears, available over-the-counter, soothe the eyes and give temporary relief. These artificial tears work for only an hour or two, at best, and must be repeated at frequent intervals. Ointments last longer, but they blur vision and are most effective at night.

Newer techniques to treat dry eye include plugs which block the tear duct. These plugs can be placed in the two tear ducts, top and bottom, in both eyes or in only the lower ducts. Some test plugs are also available which dissolve a few days after insertion. If the dry eye symptoms disappear when the temporary plugs are inserted, then permanent plugs should be considered as a treatment option.

Corneal Abrasion

A corneal abrasion occurs when the outer layer of the cornea, called the epithelium, is torn away. (The cornea is the clear outer coating of the front of the eye.)This can occur by a variety of means such as a finger in the eye, a tree limb, flying glass in an automobile accident, etc. It is one of the most common injuries to the eye.

The corneal has more nerve endings than virtually any other part of the body. Because of these many nerve endings, any damage to the cornea is very painful. Abrasions usually heal in a short time period, sometimes within hours. But while they are healing they can cause excessive tearing, redness, blurred vision and light sensitivity. In many cases, the cornea will heal overnight during sleep. If treatment is needed, it consists of a tight patch to keep the lids from moving and pain relievers as needed for comfort.

An antibiotic may be used following an abrasion because the open area of the epithelium invites infection. Small abrasions heal rapidly. However, if one covers more than one-third of the cornea, it may take an extra day or two for the epithelium to completely recover the front of the cornea.

Typically, an anesthetic is used in the eye doctor's office to ease the pain and to aid in the examination. After the examination, the pain typically returns. But, repeated use of anesthetic can harm the eye and is therefore not used in the treatment of abrasions. It may take several weeks for all the blurriness to resolve. Permanent loss of vision is very rare with superficial abrasions.

DO NOT rub the eyes during the healing phase following an abrasion. New cells require time to re-connect to the non-damaged layers of the cornea. These new cells can be easily rubbed off. If the new cells get removed, the pain returns and repatching is necessary.

Occasionally, long after an abrasion has healed it recurs spontaneously, often upon awakening in the morning. This is called a recurrent erosion and represents an area of the epithelium that is not re-connected well to the deeper parts of the cornea.

The treatment is similar to that for the abrasion. Sometimes the surface of the cornea is treated with a special instrument in order to help form better connections between the corneal layers. Extended use of bedtime ointments or lubricants may also help in preventing recurrent erosions.

Ptosis

Ptosis occurs when the upper eyelid droops to an abnormal level and covers part of the eye. It can have many causes including age, injury or nerve malfunction. It can also occur at birth.

Age is the most common cause of ptosis. The muscles that elevate the eyelid stretch and become thinned, resulting in a loss of muscle tone and the inability to hold the upper lid in the proper position above the eye.

Injury is another common cause of ptosis. Trauma to the eye, such as during an automobile accident, can damage the delicate structures around and in the eye.

Sometimes ptosis can be noticed at birth. In these cases it is due to an abnormality in the development of the muscles that elevate the upper lid. Three-quarters of the time it affects only one eye.

Ptosis can also be caused by a malfunction of the nerves which control and activate the eyelid muscles. These cases are rare and proper diagnosis is important in order to avoid unnecessary surgery. When a neurological disorder is present, symptoms typically include visual complaints independent of the droopy eyelid. Difficulty reading and driving are common complaints. Raising the entire brow with the muscles of the forehead and scalp may cause headaches and eyestrain as well. In newborns, this problem must be addressed and treated properly to insure normal maturation of the visual system and the avoidance of amblyopia (lazy eye).

The most common treatment for ptosis is surgical, and there are a number of possible approaches. The goal is to tighten the muscles so that the lid is elevated to match the lid on the other side, but with a minimum of scars and side effects. One possible complication is that the muscles can be over tightened. This results in the inability to close the eye completely after surgery. Such a situation creates a dry eye condition that may be difficult to manage.

In the age-related form, both eyelids may be drooping, but only one is low enough to require surgery. Almost invariably in these cases, the unoperated eyelid will appear lower after a successful repair of the first eye. The second eye also may eventually require surgery.

Glaucoma

Glaucoma is one of the leading cause of blindness in the United States. It is a disease that typically affects older people, but it can occur at any age. Loss of vision is preventable if the disease is detected early and treatment is started.

The eye has about 1 million tiny nerve fibers which run from the back of the eye to the brain. These nerve fibers allow us to see. Glaucoma is a disease which causes the destruction of these fibers. It was once thought that the loss of these fibers was due to strictly to high pressure in the eye. But now it is known that even patients with normal eye pressure can have glaucoma and loss of these nerve fibers.

In many patients, the disease is not noticed in the early stages, because there is no pain and no noticeable change in vision. Early detection by an eye doctor is the key to the prevention of vision damage from glaucoma. Routine eye examinations are recommended.

Types of Glaucoma

The reason that eye pressure is high in many glaucoma patients is that the drainage system in the eye is not working properly. The fluid in the eye, called aqueous humor, does not flow out of the eye as quickly as it should. The drainage system lies in a part of the eye called the angle, which is between the outer layer and the iris of the eye. This angle can be open or closed.

There are several kinds of glaucoma. The most common form of glaucoma is called chronic open angle glaucoma. The drainage angle is open in these patients, but the eye fluid does not drain as quickly as it should. Closed-angle glaucoma occurs when the drainage angle closes, and almost no eye fluid can escape. During closed-angle glaucoma, eye pressure can get very high and there is pain. Angle closure glaucoma is an emergency and must be treated immediately. If the high pressure is allowed to continue for too long, blindness can result.

Some persons are more likely to have glaucoma. These include persons who are older, have nearsightedness, have a family history of glaucoma, have had past eye injury, have diabetes or have a past history of vascular shock. Also, African-Americans are 6 times more likely to have the disease.

Glaucoma is treated with eye drops that lower the eye pressure. If the pressure does not fall to a low enough level with drops, then surgery may be necessary. Glaucoma surgery opens up the drainage system in the angle so that the eye fluid can flow more freely.

Ocular Migraines

The classic migraine is a severe headache, which in some instances may be accompanied by nausea. Ocular migraines are visual disturbances in which visual images look gray or have a wavy appearance. They almost always occur in only one eye. Other common symptoms are loss of vision, particularly in one eye, and increased sensitivity to bright lights. The visual distortion, when it occurs, normally starts in central vision and then moves off to one side.

The ocular migraine can occur either in conjunction with the common migraine or without the corresponding headache. Generally, when it accompanies the common migraine, the visual disturbances happen before the onset of headache symptoms. In younger people with common migraine, it is typical for the ocular migraines to also occur. As people age, it becomes more common to experience ocular migraines without headache symptoms.

In general there is no serious complications caused by ocular migraine. Treatment, in most instances, is not necessary unless the ocular migraine is linked to the common migraine.

Blepharitis

Blepharitis is an infection of the eyelids. It is very common, and it is a permanent condition. Once it is present, it will always be present, but the severity may change over time. In some cases, the symptoms can disappear for long time periods, months or years, before returning. Blepharitis can be controlled by careful cleaning of your eye lashes every day. This can be accomplished with warm water and mild shampoo (such as baby shampoo). Once the redness and soreness are under control, this cleaning may be decreased from daily to twice weekly. However, if the symptoms return, daily cleansing must be resumed immediately. Medication is of secondary importance in the treatment. In some cases eye drops or ointment will be prescribed to be used along with the daily cleansing.

However, medication alone is not sufficient; keeping the eyelids clean is essential. Warm, moist compresses can also help relieve the symptoms of blepharitis when used in conjunction with regular eyelid cleansing.

There are two main causes of blepharitis: staphylococcus bacteria and seborrhea. Staphylococcus bacteria commonly begins in childhood and continues throughout adulthood. Common symptoms include collar scales on lashes, crusting, and chronic redness at the lid margin. Dilated blood vessels, loss of lashes, sties, and chalazia also occur. Treatment is very important. In addition to eliminating the redness and soreness, treatment can prevent potential infection and scarring of the cornea and conjunctiva.

Seborrhea is secondary to overactive glands causing greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Hormones, nutrition, general physical condition and stress are factors in seborrhea.

Diabetic Retinopathy

Diabetes is a disease which affects the blood vessels throughout the body, particularly vessels in the kidney and eye. When the blood vessels in the eye are affected, this is called diabetic retinopathy.

The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits these to the brain. There are major blood vessels which lie on the surface, or the front portion, of the retina. When these blood vessels are damaged due to diabetes, they may leak fluid or blood and grow scar tissue. This leakage affects the ability of the retina to detect and transmit images.

Diabetic Retinopathy is the leading cause of new blindness among adults in the United States. If untreated, there is a risk of becoming blind. The longer one has diabetes, the higher the incidence of developing diabetic retinopathy. Approximately 80% of people who have diabetes for 15 years have some damage to their retinal vessels. With today's treatment only a small percentage of people have serious vision problems.

There are two types of diabetic retinopathy. Background retinopathy is considered the early stage. Reading vision is typically not affected, but it can advance and cause severe vision problems. There are usually no symptoms with background diabetic retinopathy. An exam is the only way to diagnose changes in the vessels of your eyes.

When the retinopathy becomes advanced, new vessels grow, or proliferate, in the retina. These new vessels are the body's attempt to overcome and replace the vessels which have been damaged by diabetes. But these new vessels are not normal. They may bleed, which causes vision to become hazy and sometimes causing a total loss of vision. These new vessels can also damage the retina by forming scar tissue and by pulling the retina away from its proper location. This stage, called proliferative retinopathy, requires immediate medical attention. Treatment is necessary to prevent severe loss of vision. Regular eye exams are crucial for all persons with diabetes. The progressing damage to the blood vessels in the eye can be slowed with treatment.

Detached Retina

The retina lies in the back of the eye. It is a multi-layer tissue which is responsible for detecting visual images and transmitting these to the brain. The retina is similar to the film inside a camera. A retinal detachment occurs when it pulls away from the back of the eye.

Typically following a retinal detachment, different types of images appear. These include flashing lights, an apparent covering or curtain over part of the visual field or many floaters. Importantly, these symptoms can also be present without a retinal detachment. An immediate exam is necessary if you experience these symptoms.

Sometimes the retina does not fully detach, but only tears. In these cases, treatment is done with a laser or freezing technique (cryotherapy) that seals the tear. If the retina is fully detached, surgery is performed to place the retina back into position.

Retinitis Pigmentosa

The retina lies in the back of the eye and is a multi-layered tissue which detects visual images and transmits them to the brain. Retinitis pigmentosa (RP) refers to a group of related diseases which tend to run in families and cause slow but progressive loss of vision. In retinitis pigmentosa, there is gradual destruction of some of the nervous sensors in the retina.

The first symptoms usually occur in youth or young adulthood, although it may be first seen at any age. Retinitis pigmentosa causes night blindness and loss of side vision. In normal persons, the visual system adjusts to darkness after a short period of time. People with night blindness adjust to darkness very slowly, or not at all. Due to the loss of side vision (peripheral vision) in patients with retinitis pigmentosa, mobility becomes more difficult.

Most forms of retinitis pigmentosa are inherited. Different patterns of heredity are associated with different degrees of progression. An attempt to know more about how severely the disease has affected other family members may help predict how a specific person might ultimately be afflicted, though variability exists within each family. Such knowledge is also helpful in making decisions about such things as marriage, family and occupation.

In general, there is no specific treatment. Recent research suggests that some patients may benefit from certain kinds of vitamin therapy. But these studies are not conclusive. Much research is directed toward solving this problem. Periodic examinations by an eye doctor are advised.

It is important to keep in mind that patients with retinitis pigmentosa may develop other treatable disease, such as glaucoma or cataracts. Low vision aids may be prescribed. In some cases, retinitis pigmentosa may be associated with other disease processes which might need evaluation by other medical specialists.

Despite visual impairment, the many rehabilitative services that are available today allow patients with retinitis pigmentosa to live meaningful and rewarding lives.

OUR COMPREHENSIVE SERVICES:

• Primary Eye Care including General Eye Exams
• Ambulatory Surgery Center for Comfortable and "Close to Home" Outpatient Eye Surgery
• Advanced Technology Cataract Surgery-"No Stitch, No Patch, No Needle"
• Advanced Technology Lens Implantation and Lens Replacement Surgery
• Comprehensive Laser Eye Surgery Center
• Medical and Surgery Treatment of Corneal Disease including Corneal Transplants
• Medical and Laser Eye Surgery for Diabetic Eye Disease
• Diagnosis, Surgery and Treatment of Glaucoma
• Laser Eye Surgery for Glaucoma

REFERRALS

If your insurance or HMO requires a referral to a specialist, you must bring this with you at the time of service. If another doctor has sent you to us, we will provide a written report to that referring doctor.

EMERGENCY CALLS

If you have an emergency after hours, please call the above office phone number. Our answering service will ensure that our on-call doctor contacts you.

FEES, INSURANCE, BILLING

We make every effort to keep our fees reasonable for all patients. We request that payment for office visits be made at the time of service. We accept checks, VISA & MasterCard. We will file all insurance claims for you for office visits, diagnostic services, and surgery. We are participating providers with most local HMOs. Please notify our staff of your insurance coverage when you make an appointment. If a referral is required, please be sure to bring it with you for your visit. All co-pays will be collected at the time of service.