How Do We Treat Astigmatism?

Astigmatism is an optical or focusing problem caused when one or more parts of the eye are shaped like a football instead of a basketball. This causes a situation where TWO points of focus are created inside the eye, and sometimes neither of those points is focused right on the retina (the part of the eye that "sees"). This makes your vision blurry.

We can correct astigmatism in several different ways. Let's introduce them today. Of course, the easiest way to correct astigmatism is to wear a pair of glasses. Your prescription will not only correct for SPHERE (nearsightedness or farsightedness), but also for CYLINDER (your astigmatism). For all but the most extreme cases of astigmatism a pair of glasses might be all you need.

There are two types on contact lenes that will correct your astigmatism, both soft (toric) and hard (gas permeable). Soft Toric contact lenses from companies like Bausch & Lomb and Acuvue are much better now than in years past, giving good vision and lots of comfort. Many people still see better with glasses but strongly prefer their contacts because of the freedom they have with the contacts.

We can also treat your astigmatism with Laser Vision Corrections like LASIK where we literally put the correction right on the surface of your eye. There are also new implants called Toric IOL's that can correct astigmatism if you have cataracts. We'll talk about these two things in detail another time.

So if you live in the Cleveland area and you have ASTIGMATISM, call Skyvision Centers in Westlake so that you can see how you can See What's Next(R)!!

AN INDEPENDENT LASIK INFORMATION RESOURCE - ARSC

Do you wear glasses or contact lenses? 

                                                             

 Have you been thinking about LASIK? 

We found a new, independent resource that provides very high quality information about LASIK and some other eye surgeries.  The American Refractive Surgery Counsel (www.americanrefractivesurgerycounsel.org) provides a website with good, solid, independent information about LASIK. 

The ARSC website does not promote any individual LASIK surgeon or practice.  There is a refractive surgery checklist which you can use to evaluate your options.  In addition, there is a blog that posts updates about interesting stories about LASIK.

We think the American Refractive Surgery Counsel website is a very nice resource for those people thinking about LASIK surgery.  We encourage you to give it a look!

Tools for Patients’ Education

BY DARRELL E. WHITE, MD

Educate cataract patients before they even arrive at your office for the examination.

Cataract surgery is one of the most successful surgeries in all of medicine. It also enjoys a very low

complication rate. With the aging population in this country, most patients know someone who has undergone the procedure. In addition, the newest IOL technology offers patients the possibility of excellent

vision at all distances without glasses. Efficiently and effectively educating patients on cataracts and the options for IOLs, however, can still be a challenge. In my practice, we have found that an effective patient education plan starts as soon as the individual contacts our office. The plan provides patients with ample opportunity to familiarize themselves with their pathology and the treatment

options before they have any decisions to make.

PATIENTS’ EDUCATION STARTS EARLY

When a patient makes an appointment with our office, whether he or she was referred by an optometrist,

a patient who is a friend or family member, or is following up from a previous experience in our office, the front office staff member always asks for certain demographic information including age and e-mail address. For the 50% to 60% of patients from whom we are able to obtain an e-mail address, we send them an introductory message before they come in for their appointment. For patients in the cataract demographic, the e-mail message they receive includes information about our office and links to interactive educational software (ECHO, Eyemaginations, Inc.) about the pathophysiology of cataracts as well as an introduction to premium lens options for the patient to view.

When the patient arrives at the office, the file is “flagged” to identify him or her as a cataract patient. A technician escorts the individual into the examination area, takes the history, and begins a diagnostic evaluation.  If it is clear that the patient has a cataract, his or her visual function is measured in several different ways including tests to determine the level of astigmatism. While the patient is waiting for the dilating drops to take effect, the staff has him or her watch a simple video of me explaining the cataract process, what the experience is like, and informing him or her about lens options. I emphasize that all of the implants are good options and he or she will see well with each of them. Then, I outline the differences between what we call the basic high-tech implant, the advanced distance high-tech implant (a toric IOL), and the advanced distance and near implant (a presbyopia correcting IOL). During the dilation, the staff will also play educational videos on the Eyemaginations LUMA platform in the examination rooms to reinforce the information that the patient has already received.

PRE-EXAMINATION BY THE OPTOMETRIST                     

Once the patient is dilated, an optometrist performs the pre-examination to determine whether or not the patient can be corrected with spectacles and also evaluates the cataract’s size and severity. The optometrist expands on the information provided in the educational video, reintroduces the concept of choice, and alerts the patient to whether or not all three options are available. For example, we know that if the patient has macular degeneration, a presbyopia-correcting IOL is likely not an option. The optometrist also encourages patients to fill out a lifestyle survey and dives a little deeper into their visual life: how do they use their eyes, what activities do they participate in, and what is most important to them. The goal is to find out what will make patients the happiest.

SURGEON’S ROLE

This is the point at which I come in, confirm the diagnosis, determine whether the patient is a surgical candidate, and answer any questions. After I review the IOL options, I ask the patient to make a choice regarding which implant he or she would like to receive.

Nationwide, approximately 9% of cataract patients choose a premium IOL, according to Market Scope. Our conversion rate was consistently 22% until about 3 years ago when we made two distinct changes. First, I created the video that we have all cataract patients watch while their eyes are dilating. Second, we started e-mailing all possible cataract candidates the ECHO educational software about cataracts and the premium lens options. Since we have implemented those two strategies, the percentage of patients that choose premium IOLs has increased to 35% and has remained at this figure for the last 2 to 3 years. 

Our patients’ experience has always been centered on trying to access their learning strategies in as many different ways as we can. We interact with them verbally, we provide printed material, and because we know many people are visual learners, we offer interactive media as well.

TIMING OF EDUCATION

In addition to the specific materials, timing is a very important element of patients’ education. The first time

patients hear that they have a cataract, they are not really able to pay attention to anything else. Although they may have friends or family members who have undergone successful procedures, they are still trying to mentally digest the diagnosis. By our office sending an email and starting their educational process at home before they ever come into the office, we have moved that emotional reaction upstream from the decision point.  When I meet with cataract patients in the examination room, they have accepted their diagnosis, they have been educated on the disease’s pathology and the surgical procedure, and I am able to answer any remaining questions.  I can then help them decide which IOL is right for them. I spend less time explaining what a cataract is and more time discussing what constitutes their visual life, what things are important to them, and how they use their eyes. I believe that my patients now are more comfortable with the decisions they make.

It is very frustrating for physicians and patients when a  patient chooses a standard IOL and then has “non-buyer’s remorse”—they wish they did not have to wear reading glasses, for instance. Today, that does not happen as often as it did previously because patients have been presented with the information on the IOL options several times before they are required to make a final decision.

CONCLUSION

After discounting the first 2 years of explosive growth in the practice, we have consistently grown 8% to 11% each year with no external marketing and a very small, dedicated base of referring optometrists. Although it is difficult to measure exactly, our best guess is that our growth has come from referrals from satisfied patients: we simply encourage our patients to send their friends, family, and colleagues to our practice. I believe a large part of our success is that we very openly make every effort we can to educate our patients about their disease process. Our patient-education plan is a central part of what our version of a patient-centered medical experience should be. 

Darrell E. White, MD, is the founder of Skyvision Centers of Westlake, Ohio. He is a consultant to Eyemaginations, Inc. Dr. White may be reached at dwhite2@skyvisioncenters.com.

Advanced Ocular Care Magazine March 2013

Treating Astigmatism In Patients With Cataracts

Modern cataract surgery is not your grandfather's surgery! If you have asigmatism we can not only make you see better over-all, but we can also treat your astigmatism. Dr. Darrell White is an expert in using Intra-Ocular Lenses (IOL's) that correct astigmatism.

A cataract is a clouding of the natural lens inside your eye. The lens sits in back of your pupil. As we get older the lens becomes harder, making it harder to focus. This is why we need reading glasses in our 40's. As we get even older (and sometimes in younger people, too), part or all of the crystalline lens becomes cloudy, sometimes yello-brown, too. This makes our vision blurry even with glasses or contact lenses. When that happens the only treatment is to take the cataract out.

If you have astigmatism you can choose to NOT HAVE TO WEAR GLASSES for most (maybe all!) of your far-away vision. You can choose to have Dr. White put in a Toric IOL, an implanted lens to give you clear vision AND correct your astigmatism. Imagine...after a life of glasses and contact lense for astigmatism...after cataract surgery you could choose not to have to wear glasses for lots of your far-away vision!

If you live in the Cleveland area Dr. Darrell White and Skyvision Centers in Westlake are the people and the place for expert treatment of astigmatism when you have cataract surgery!

Trends In Treating Astigmatism

The surgical revolution in treating astigmatism began with the onset of Radial Keratotomy (RK) in the late 1970's and continued into the era of Laser Vision Correction. When a cataract was to be replaced, if you had astigmatism you either had to undergo a procedure like RK called a Limbal Relaxing Incision (LRI) during or after the surgery, or a laser procedure like LASIK or PRK. These all work well.

About 5 years ago there was a new development in Intra-Ocular Lenses (IOL) that not only improved vision after cataract surgery, but also treated astigmatism: Toric IOL's. A study of refractive cataract surgeons like our Dr. White recently reported that 75% now prefer to use these new IOL's rather than LRI's in patients with astigmatism.

"We really like the Alcon Toric IOL when we are aiming to make our  Cleveland patients independent from glasses for their distanc vision needs like driving or watching TV," said Dr. White.  "Our golfers are particularly happy!"

Extra pre-operative measurements like corneal topography are necessary to choose both the power and the orientation of the IOL. Once it's in the eye it is amazingly stable!

The technology of cataract surgery now includes multiple ways to address astigmatism. Dr. White and a majority of the top surgeons in the United States are now opting for a Toric IOL in cases where astigmatism is treated during the surgery.

What Is Astigmatism?

What is Astigmatism? It's a funny word, isn't it? Lots of people think the word is "stigmatism" and that you have "a stigmatism". That of course means that you could have one or more "stigmatisms", but that's not really how it works!

Astigmatism is an optical term that relates to how an optical system focuses, or doesn't focus, light. In our situation the optical system is the eye! There are three different parts of the eye that make up the focusing elements of our vision system: the TEAR FILM that sits on the very surface of the eye (that's why Dry Eye causes vision problems!), the CORNEA or window to the eye, and the LENS that sits in back of the pupil. Astigmatism is present when the combination of these pieces parts creates two or more focused images from a beam of light.

Most of the time astigmatism is caused by the shape of the CORNEA. In a normal eye, one without astigmatism, the cornea is like the front of a sphere; it's round like a basketball or a soccer ball. A cornea that has astigmatism is longer in one direction than the other. It's STEEPER in one direction and FLATTER in the other. In other words the astigmatic cornea is shaped like a football instead of a basketball.

Whether you are nearsighted or farsighted, if you have astigmatism you will have at least two images focused in the eye. There are lots of ways to correct this, and we'll talk about all of them as time goes on. Be sure to check here, and watch for the Dr. Whiteboard videos on the SkyVision Centers Youtube channel SkyVisionCenters105 for more info on ASTIGMATISM

Detection and Treatment of Refractive Errors

Your eye doctor determines the type and degree of refractive error you have by performing a test called a refraction.

This can be be done with a computerized instrument (automated refraction) or with a mechanical instrument called a phoropter that allows your eye doctor to show you one lens at a time (manual refraction).

Often, an automated refraction will be performed by a member of the doctor's staff, and then the eye care practitioner will refine and verify the results with a manual refraction.

An eye care practitioner performs a manual refraction. Your refraction may reveal that you have more than one type of refractive error. For example, your blurred vision may be due to both nearsighted and astigmatism.

Your eye doctor will use the results of your refraction to determine your eyeglasses prescription. A refraction, however, does not provide sufficient information to write a contact lens prescription, which requires a contact lens fitting.

Eyeglass lenses and contact lenses are fabricated with precise curves to refract light to the degree necessary to compensate for refractive errors and bring light to a sharp focus on the retina.

Vision correction surgeries such as LASIK aim to correct refractive errors by changing the shape of the cornea, so that light rays are bent into a more accurate point of focus.

by Gary Heiting, OD

Toric Soft Contact Lenses

Once upon a time, if you had any astigmatism at all you couldn't wear soft contact lenses. That's why Dr. White wore gas permeable rigid contact lenses before he had LASIK surgery. The early versions of soft contact lenses for astigmatism, called "TORIC"  soft lenses, were definitely better than nothing, but they suffered from poor stability on the eye and poor comfort.

There have been many very cool advances in contact lens technology, but one of the coolest has to be the new toric soft contact lenses for astigmatism. One of Dr. Kaye's favorites is the Air Optix Aqua Toric. It has a range of powers up to 2.25 of astigmatism, a pretty high amount. Dr. Kaye is also impressed by how well it fits and how stable it remains on the eye.

As you know, the doctors at Skyvision Centers are the leading experts in Dry Eye in Cleveland. All contact lenses can make your Dry Eye worse, but the Air Optix is made from a material that is particularly helpful for patients with Dry Eye.

Do you have astigmatism? Tired of wearing your glasses because your contacts don't work as well? Call us at Skyvision Centers and chat with Dr. Kaye about giving the Air Optix Aqua Toric a try!

Eye Doc Education 3.0!

This evening the doctors of SkyVision Centers will be hosting their 3rd educational seminar for local eye doctors. The first two seminars were rousing successes and we expect nothing less tonight. Each session has included two talks by either our very own SkyVision docs or invited guests. The topics covered have included the new Tear Osmolarity technology and Cataract Implants for Astigmatism among others. In addition, the two meetings have included very interesting dinner fare!

Attendees at 1.0 were treated to an Italian feast with accompanying Italian wines, while 2.0 featured artisinal pizza and Brew Kettle beer brewed especially for the meeting!

Tonight the speakers will be Dr. Darrell White and Dr. Scott Schlegel. Dr. White will introduce the concept of "service lines" in the development of protocols to diagnose, treat, and follow specific diseases in "Glaucoma Protocol Development I". Dr. Schlegel will be tackling the subject of introducing a patient with cataracts to the choices they will face when then are trying to decide what type of Intra-Ocular lens to use for their surgery.

What about dinner? Well, tonight we will be serving Mexican! Their will be a fajita bar with all of the fixin's, traditional Mexican cookies, and of course something interesting to wash it all down! We are all looking forward to seeing our friends in the eye care community as we gather to improve our collective understanding of how best to treat our patients.

RevitalVision and Dr. White

Our own Dr. Darrell White is about to embark on his own RevitalVision training! "I've been having just a little bit of blurriness when driving, especially at night," said Dr. White. "After my LASIK in 1999 I've really only had to wear reading glasses after turning 45 or so (Dr. White is now 52). My corneas were so thin that I was only going to be able to have LASIK done once so the little distance prescription I now have needs to be taken care of some other way."

Enter RevitalVision! Most of what Dr. White has in the way of a distance vision problem is due to a little bit of astigmatism. The perfect solution for him is the RevitalVision Sportsvision program. We are awaiting delivery of the module right now.

Dr. White: "I"ll report on my progress and the experience right here! I can't wait to get this permanent improvement and stop wearing my driving glasses again."

GET AN EYE EXAM BEFORE YOU GO FOR YOUR DRIVER'S LICENSE RENEWAL

Written By:  Healthy Aging Admin  10-4-2008
Categorized in: Health News

It's your birthday soon and in many states that means your driver's license might be up for renewal.

When was the last time you had an eye exam? Don't be vain or shy. Not knowing if you will pass or not is stressful. Go into your next exam armed with the knowlege that your eye sight is good or that you have taken the corrective measures to make your sight "driving safe".

During driving, the eyes are constantly on the move -- looking at vehicles ahead and to the side;
reading road traffic signs; checking the rear and side view mirrors, and shifting their gaze between external and internal environments in order to check the speedometer, read a map on a global navigation system, change a radio station, or search for a dropped item in the car.

During darkness, these tasks can become more difficult for some drivers. A driver with 20/20 vision during the day can experience a reduction of visual acuity to 20/40 at night.

Research findings from the Pennsylvania Department of Motor Vehicles indicate that over half of those who fail a DMV vision exam are unaware that they have a vision problem. One in four (25 percent) Americans said it has been more than two years since their last eye exam, according to Americans’ Attitudes & Perceptions About Vision Care survey, conducted by Harris Interactive® on behalf of The Vision Care InstituteTM, LLC, a Johnson & Johnson Company.

“Getting behind the wheel of a car with an uncorrected or improperly corrected vision problem can have tragic consequences,” says California-based optometrist Dr. Elise Brisco. “A comprehensive eye exam will include testing to diagnose potential problems and determine the correct form of treatment.”

In the Harris survey, 80 percent of respondents said they believe that correcting vision problems can improve their driving a great deal.

Having a regular eye exam is all part of the Healthy Aging® prevention checklist.

Below are some common vision problems and how they can impact driving.

Distance vision

Poor distance vision and excessive speed can have disastrous results. If your distance vision is poor, you may not see hazards until it's too late to react safely. The faster you travel, the less time you have to see things and react to them.

Depth Perception

You need to be able to judge distances well to pass other vehicles and change lanes, especially in busy traffic. The inability to judge distance can result in the driver stopping too short of the limit line or inside the intersection, turning too wide or too short, and/or failing to maintain speed and/or following distance appropriate for prevailing driving conditions. Poor depth perception also can result in “fender benders” and make parking more difficult.

Accommodation (near vision focusing)

When you're driving, you need to look from the road to the dashboard and back again quite often. This ability to change focus from far to near is called accommodation or near vision focusing. Over the age of 45, most people have increasing difficulty with near vision, and may need bifocal or progressive lenses or contact lenses to help see at all distances from far to near.

Field of vision (peripheral)

In driving, peripheral or side vision is used in part to detect information that may be important for safe driving, such as road signs, appearances of hazards, and changes in the flow of traffic. The ability to see to both sides is important. You need to be able to see cross traffic, pedestrians, and animals at the roadside, without having to look away from the road ahead.

Peripheral vision is also used in controlling the vehicle. When the driver looks in the rear view mirror, peripheral vision is used to monitor traffic in front of the vehicle. In keeping the vehicle centered in the lane, peripheral vision is used to monitor the lane boundaries. Peripheral vision impaired by one or more vision conditions can result in the driver failing to react to a hazard coming from the driver's far left or far right, failing to heed a stop light suspended over an intersection, weaving while negotiating a curve, and/or driving too close to parked cars. Additionally, due to the frame, some eyeglasses also can block peripheral vision so that when looking sideways, upwards or downwards, the wearer is looking outside the perimeter of the lens.

Astigmatism

Astigmatism is a vision condition that occurs when surfaces of the eye, such as the cornea, have an oval shape -- like an egg. This shape prevents light from focusing properly on the back of the eye, the retina. People with uncorrected astigmatism will usually have blurred vision, and in some cases may also experience headaches, eyestrain, or fatigue.

Night vision

The visual ability of two drivers may be about the same during the daylight hours and be markedly different during night or other low-light situations. For example, twilight is one of the most difficult times to drive, because eyes are constantly changing to adapt to the growing darkness.

Drivers need to be able to see in low and variable light conditions, and recover quickly from the glare of oncoming headlights. Glare recovery is best in drivers under the age of 30, and night vision can deteriorate after the age of 40.

Driving safely at night requires seeing well not only under low illumination, it also requires one to see low contrast objects. Someone wearing dark clothes and crossing the street in front of the driver is much harder to detect at night than during the day because there is much less contrast at night between darkly clothed pedestrians and a dark background.

Night vision impaired by one or more vision conditions can result in a driver at night failing to react to hazards located directly in front of the vehicle, tailgating, and/or failing to steer when necessary because the driver is unable to see low contrast features of the roadway such as its edges and irregularities in the road surface.

Color vision

Color plays an important part in road safety. Drivers must instantly recognize traffic lights, indicator signs, hazard warning lights and stoplights, and people with color vision defects may react slower to them.

SOURCES: ACUVUE, Mayo Clinic

Astigmatism 101

What is Astigmatism? It's a funny word, isn't it? Lots of people think the word is "stigmatism" and that you have "a stigmatism". That of course means that you could have one or more "stigmatisms", but that's not really how it works!

Astigmatism is an optical term that relates to how an optical system focuses, or doesn't focus, light. In our situation the optical system is the eye! There are three different parts of the eye that make up the focusing elements of our vision system: the TEAR FILM that sits on the very surface of the eye (that's why Dry Eye causes vision problems!), the CORNEA or window to the eye, and the LENS that sits in back of the pupil. Astigmatism is present when the combination of these pieces parts creates two or more focused images from a beam of light.

Most of the time astigmatism is caused by the shape of the CORNEA. In a normal eye, one without astigmatism, the cornea is like the front of a sphere; it's round like a basketball or a soccer ball. A cornea that has astigmatism is longer in one direction than the other. It's STEEPER in one direction and FLATTER in the other. In other words the astigmatic cornea is shaped like a football instead of a basketball.

Whether you are nearsighted or farsighted, if you have astigmatism you will have at least two images focused in the eye. There are lots of ways to correct this, and we'll talk about all of them as time goes on. Be sure to check here, and watch for the videos on the Dr. Whiteboard over on Youtube for more info on ASTIGMATISM.