Cataracts are the term given to a clouding of the natural lens in the eye. Everyone is born with a clear lens inside the eye. This clear lens allows light to pass into the eye and clearly focus on the retina on the back wall of the eye as in the top image on the right. With normal aging, the lens becomes cloudy and the light rays cannot focus clearly on the retina but are scattered causing poor vision as in the bottom image on the right. The cataracts will continue to grow and cause a greater decrease in vision with natural aging. Eventually, vision will decrease to the point that it interferes with normal daily tasks and the patient will need to undergo cataract surgery to remove the cloudy lens and replace it with a clear plastic lens.

There have been tremendous technological advances in cataract surgery over the last few years and now patients have many options to choose from for the type of clear plastic lens that is placed in the eye. Standard monofocal lenses can correct some patients for distance vision but you will need to wear bifocals or readers after the procedure to see up close. Toric lenses are another great option for patients with astigmatism as they can help patients with astigmatism achieve more independence from their glasses. Lastly, multifocal lenses can allow patients a range of vision both near, intermediate, and far without glasses following cataract surgery. Dr. Moss will have a detailed discussion with you at the time of cataract booking to review all your goals and options to help you select which lens is right for you.

Glaucoma is actually a family of conditions where the optic nerve taking information to the brain is damaged. We know the many forms of glaucoma have a genetic predisposition so if you have any family members with glaucoma it is especially important that you undergo a screening eye exam. Many forms of glaucoma have an association with increased pressure inside the eye. This pressure buildup damages some of the nerve fibers of the optic nerve causing first the loss of peripheral then central vision.

Glaucoma normally is not painful and many people who have it don’t know it until it is in the advanced stages. Once vision is lost from glaucoma it is irreversible so the key is preventing the damage before it ever happens. Usually we treat our glaucoma patients with a combination of drops and/or lasers to lower the pressure inside the eye. Recently, many new minimally invasive glaucoma surgery (MIGS) procedures have changed the way glaucoma is treated. We will thoroughly discuss all the treatment options for your glaucoma with you to find one compatible with our mutual goals.

Pterygia are fleshy growths that occur on the surface of the eyes. The normally clear conjunctiva overlying the white sclera of the eye begins to grow onto the surface of the cornea. A pterygium is associated with increased sun exposure. It can adversely affect vision in many different ways. It can become red, inflamed and painful or cause a patient to have a persistent foreign body sensation on the surface of the eyes. As it grows further onto the cornea it can obstruct the vision completely if it covers the pupil or it can pull on the surface of the underlying cornea and cause astigmatism. Pterygiums are usually treated with surgery that is quick and relatively painless under local anesthesia. There is always a risk of the pterygium growing back but we take several additional steps in the surgery to minimize the chances of recurrence.

Nearly everyone has experienced the discomfort of dry eyes at one point in their lives and chronic dryness is a very common condition. Not only does dryness adversely affect how your eyes feel and look, it can actually affect your vision as well. In order to treat the dry eye, we’ll need to first identify any environmental factors as well as underlying medical conditions, possible drug side effects, and other known associations. Treating the dryness can sometimes be as easy as starting artificial tear eyedrops. For those patients who still have signs of dryness, we might suggest vitamin supplementation, moisture goggles, specially formulated tears, punctal plugs, or a prescription anti-inflammatory eyedrop. We cater our treatment plan to each individual patient’s unique needs.

Diabetes can cause multiple problems in the eyes of patients, especially those whose blood sugars are not well-controlled. Early cataract formation and refractive changes often happen in diabetic patients but the majority of changes occur in the retina. Chronic high sugar levels in the blood lead to damage in the small blood vessels of the retina over time. Once damaged, they can leak fluid into the retina which becomes swollen in a condition called macular edema. This swelling leads to major deterioration in central vision. In addition, further changes in the vasculature can lead to the growth of fragile new blood vessels in the back of the eye. These vessels rupture causing bleeding into the vitreous gel inside the eye and a shower of floaters. Many of these sight-threatening complications of diabetes can be prevented with careful followup eye exams and strict blood sugar control. Some patients require laser treatments to the eye or an injection of medication into the vitreous gel. Occasionally some patients may even require surgery to clear out the blood in the vitreous. We customize our treatment plans for diabetes and actively work in partnership with primary care doctors and endocrinologists in order to assess control and compliance and avoid as much further retinal damage as possible.

Age-related macular degeneration (ARMD) is among the leading causes of blindness in the developed world and is divided into two main classifications, wet and dry. In both conditions, the eye starts to accumulate little yellow collections underneath the retina known as drusen. Sometimes these drusen will become numerous and coalesce together causing focal blind spots in the overlying retina. This is the hallmark of the dry form of ARMD. Wet ARMD patients get drusen formation and then develop new blood vessels into the overlying retina which leads to fluid accumulation underneath the retina. These blood vessels normally respond to injections of medicine into the eye in what is called an intravitreal injection. Many different medications are used for this purpose and the type of medicine needed will be tailored to each individual patient. Everyone with a known family history of macular degeneration should be screened for the disease as its known to be highly genetic. Some patients benefit from a special multivitamin aimed specificially at retinal nutrients.

The retina is a thin piece of nerve tissue that lines the inside wall of the back of the eye. Think of it as the film in a camera. Even if everything at the front of the eye is working correctly, the retina must be functioning for a good image to be sent to your brain. Normally the retina is tightly adherent to the wall. Sometimes, small breaks or tears can occur in thin parts of the retina through normal aging and the separation of the vitreous gel away from the retina. When these occur, fluid can enter the breaks and cause the retina to peel off from the back wall of the eye. In areas that are detached the retina cannot see so patients experience a curtain-like sensation in the regions of their retina that are already detached. This is considered an emergency and will usually require a surgery to fix. After the surgery, you may have a gas bubble on the inside of the eye and have to maintain face-down positioning while you recover. You also won’t be allowed to go on a plane or any other elevation changes until the gas bubble is completely gone.

With normal aging, the vitreous gel inside the eye changes composition. It slowly begins to separate away from the underlying retina inside the eye. When this occurs, the vitreous and retina can be tightly attached and some tugging on the retina might occur. Patients usually notice this as flashes of light when traction is exerted on the retina. If the attachment is even stronger, a small tear might be created in the retina as the vitreous separates away. This retinal tear can lead to a retinal detachment which requires surgery but often the tears can be treated with an in-office laser procedure if they are caught early enough. Anyone experiencing a sudden shower of floaters or persistent flashes in their vision should undergo a dilated eye exam as soon as possible.

With normal aging, the vitreous gel inside the eye changes composition and separates away from the retina. After this occurs, patients can start to notice floating spots in their vision at times. These spots are pieces of proteins that are no longer optically clear floating around the center of the eye. People often complain of seeing a mosquito, stray hair, or spider web moving throughout their vision. Normally floaters are incidental findings that do not cause any harm to the eye but sometimes they are significant enough that they truly interfere with the patient’s visual quality. There are three options when dealing with floaters. Waiting to see if the brain gets acclimated to the new floaters in the vision is always an option. Many floaters will be significant when they first appear but patients tend to notice them less and less over time. Another option is to undergo a laser procedure in the office to break apart the larger proteins into smaller ones that tend to block the vision less. Lastly, removing the vitreous gel from the eye with a surgery will also eliminate most of the floaters.