What’s New Items

The Implantable Contact Lens (ICL™) is a lens made of a highly biocompatible Collamer® material that is permanently implanted into the eye, providing an alternative to glasses, contact lenses and Laser Vision Correction (PRK/LASIK) surgery. It is similar in design to implants inserted routinely during cataract surgery. The implant focuses light rays onto the retina resulting in clearer vision (How this works). It is the only minimally-invasive foldable lens of its kind approved for the U.S. market by the Food and Drug Administration.

Custom wavefront ablation is a modification of conventional Laser Vision Correction. All of the eye’s unique visual errors are first measured and then downloaded into the laser for subsequent treatment with LASIK or PRK. Laser vision correction has traditionally provided the same type of correction as spectacles or contact lenses by permanently treating myopia, hyperopia, and astigmatism. Recent studies have revealed that additional subtle visual errors (called “higher order aberrations”) limit eyesight and may contribute to night glare and halos. Correcting these aberrations may improve visual outcomes after laser vision correction. The Erdey Searcy Eye Group welcomes the opportunity to discuss how individuals may benefit from this technological step forward in refractive surgery. To schedule a complimentary laser vision correction evaluation, contact us. To find out more, visit our page on Refractive Surgery, or review our Common Questions about Laser Vision Corrections.

Accommodation refers to the ability of the crystalline lens (located behind the pupil) of the eye to change shape in order to bring into focus objects located at different distances from our face. For instance, we might need to focus on the moon (infinity), our computer (intermediate, or about 60 cm) or a book (near, or about 40 cm). Different objects located at varying distances require our crystalline lens to instantly adjust to see them clearly. This process is similar to focusing a camera lens on an object when taking a picture.

There is a natural, but inevitable loss in the focusing power of our crystalline lens as we age, called Presbyopia. The ability of the crystalline lens to instantly change shape in order to focus light rays on the retina for near vision tasks gradually declines throughout life. Around age 43, most people begin to notice they must hold reading material farther away than usual. To correct this problem, bifocals, reading glasses or monovision contact lenses are increasingly required so by age 50 there is generally total dependence on corrective lenses.

View video: Why we need reading glasses as we mature.

The crystalline lens of the eye which has become cloudy and no longer perfectly transparent to light is called a Cataract; this condition results in hazy vision. Once visual function is sufficiently compromised,cataract surgery may be recommended by your doctor. The cloudy crystalline lens of the eye is removed during cataract surgery and exchanged with an artificial intraocular lens implant (IOL). If you are considerably younger than 50, and require cataract surgery, keep in mind that any remaining accommodative amplitude is immediately lost and you will typically need bifocals. For instance, a 30 yr old may require cataract surgery because of a dense lens opacity compromising vision, but the downside is this relatively young lens still has the ability to fully accommodate. After cataract surgery with IOL, vision will be expected to significantly improve, but the eye will also immediately lose the accommodation the cloudy crystalline lens had provided so this young patient will need bifocals after surgery. Conversely, older patients who require cataract surgery are already accustomed to bifocals and will still require them after surgery with a conventional IOL.

Conventional IOL

Conventional intraocular lenses (IOL’s) have a fixed focus and are not designed to restore the eye’s natural ability to focus (accommodate) following cataract removal. Until recently, patients undergoing lens implant surgery had no other choice but a monofocal, or single focus IOL. Monofocal IOL’s implanted in both eyes generally provide excellent uncorrected vision if both IOL’s are powered for distance (infinity) and pre-existing astigmatism, if any, is corrected at the time of cataract surgery; however, patient’s typically remain dependent on spectacle correction for near and intermediate vision.

Conventional IOLs and “MONOVISION”

Single focus IOL’s can be electively targeted for distance focus in one eye and intermediate or near focus in the other eye. When both eyes are open, this optical condition, called “monovision” provides good simultaneous distance and intermediate (computer distance) or reading distance but the downside is some loss of binocularity or sterovision. Not all patients tolerate such an imbalance and may not accept “monovision”. Others may gradually adapt to this imbalance over time (several months). Still others only notice problems in low light or night illumination. Distance driving glasses may be all that is needed.

If you are approaching or are in the presbyopia age range (above age 40), you may already be familiar with this arrangement if you’ve worn contact lenses set up for monovision. If you have an interest in this option, you may ask your doctor to “tailor” the surgery (leave some residual near-sighted ability in your non-dominant eye) to allow some independence from reading glasses.

Presybyopia IOL’s are more recent innovations that are designed to significantly improve depth of focus.  Use of these IOL’s during cataract extraction or refractive lensectomy may reduce or eliminate the need for corrective lenses for distance, intermediate and near visual tasks. Since both eyes are generally focused at a similar distance, stereopsis or depth perception is maximized. While Presbyopia IOL’s have definite advantages over conventional monofocal IOL’s it is important to realize that they do not yet simulate the full range of accommodation provided by the young human crystalline lens!

Unlike Conventional IOL’s, Presybopia IOL’s are NOT a covered benefit of your health insurance and instead are considered an “upgrade”. Additional out-of-pocket fees will apply if you elect this option.Payment plans are provided. Please contact us for more information.

There are currently three US FDA approved Presbyopia IOL designs,Crystalens ® (Eyeonics), Rezoom ® (AMO), and Restor® (Alcon) each using different optical principles to achieve better depth of focus. Each has advantages and disadvantages.

The following is a brief summary of the Crystalens ® and Rezoom ® and does not attempt to present a full discussion of the benefits and risks that may be associated with their use.  Be sure to talk to your doctor who will determine if you are a suitable candidate and before making any decisions about vision improvement procedures, as this information is not intended to replace the advice of a healthcare professional.

In Clinical Trials:

The crystalens accommodating intraocular lens is engineered with a hinge designed to allow the optic, or part of the lens that you see through, to move back and forth as you constantly change focus on images around you.

In the late 1990s, Advanced Medical Optics (AMO) introduced its first multifocal IOL designed to provide multiple points of focus, thereby dramatically reducing the need for bifocals or trifocal glasses after surgery. Today, with its many optical design enhancements, AMO’s second-generation ReZoom™ Multifocal IOL provides patients with a full range of vision and greater independence from glasses or contact lenses than ever before. Clinical studies show that 92% of those receiving the ReZoom™ Lens technology “never”, or “only occasionally,” need to wear glasses.1

1. Package Insert. ReZoom™ Multifocal Acrylic Posterior Chamber Intraocular Lens. Advanced Medical Optics, Inc.

Rezoom ® Multifocal Lens Technology

Balanced View Optics™ Technology literally provides multiple focal points so you can see well at a variety of distances. The ReZoom™ Multifocal Lens has five uniquely proportioned visual zones designed to provide clear vision for different light and focal distances. Due to this design, about 20% of patients with this IOL experience visually significant halos and glare, usually at night. Most patients who experience these effects report they generally become less noticeable or bothersome over a period of several months to a year due to a natural process called neural adaptation. Rarely, it may occasionally become necessary to exchange this IOL with an alternative IOL should disabling glare persist and not spontaneously resolve.

The First Steps to Resuming Life

If you suffer from poor vision, or think you might have a cataract, you should make an appointment to have a complete eye examination. Once it is determined that you are a good candidate for a Presbyopia IOL, you will be given additional information about the possible risks, complications, and costs involved with the procedure. Be sure to have all of your questions answered before giving your consent to have surgery.

Learn more about cataract surgery.

View: testimonials

There are approximately 40,000 Corneal Transplants performed each year in the United States. This is actually a small number when compared with approximately 2,000,000 cataract procedures each year in this country. Of all transplant surgery done today, including heart, lung and kidney, corneal transplants are by far the most common and successful. Richard A. Erdey, M.D., a Corneal Specialist, has been performing Corneal Transplant Surgery since 1988.

The Normal Cornea

The Human Eye is like a telescope in that it contains two lenses to focus light onto the retina. The first “lens” is the cornea It is a transparent, dome-shaped window covering the front of the eye. It is a powerful refracting surface, providing 2/3 of the eye’s focusing power. Because there are no blood vessels in the cornea, it is normally clear and has a shiny surface. Like the crystal on a watch, it provides a clear window to look through.

The cornea is tough, difficult to penetrate and is extremely sensitive – there are more nerve endings in the cornea than anywhere else in the body. For this reason, a cornea abrasion is generally very painful but fortunately, heals rapidly. The adult cornea is only about 1/2 millimeter thick and is comprised of 5 layers: Epithelium, Bowman’s membrane, Stroma, Descemet’s membrane and the Endothelium. Throughout life the cornea must remain transparent, smooth and of regular curvature to properly transmit and focus light as it enters the eye. Infections, trauma, or dystrophic conditions can involve any layer of the cornea and may result in scarring or thinning that, if severe, can cause loss of transparency and blindness.

Cross-section of the cornea. The normal cornea is about 0.55 millimeters (mm) thick in its center and consists of five microscopic layers as labeled above.  The thickness may increase to 0.68 mm or greater if swelling occurs because of endothelial cell loss.

We are born with a complement of cornea endothelial cells (3000 to 3500 cells/ mm²) that line Descemet’s membrane. These cells are responsible for “pumping” fluid out of the cornea, maintaining cornea transparency. As we mature, the concentration of these specialized cells may decrease by 1/3 but this quantity is still sufficient to maintain corneal clarity throughout life. Unfortunately, corneal endothelial cells are one of the few cells in the human body that are not capable of regeneration and if damaged or lost are not replaced.

If the cornea endothelial cell concentration falls below a certain critical threshold, as can occur in Fuchs’ Corneal Dystrophy, aftercataract surgery or after eye trauma, the cornea swells and loses transparency leading to blurry vision or eventually, blindness.

Fuchs’ corneal dystrophy is a progressive condition that gradually affects both eyes. It is slightly more prevalent in women than in men. The condition rarely affects vision until people reach their 50s and 60s although an eye doctor can sometimes detect the early signs of Fuchs’ dystrophy at age 30 to 40 years. The pathology in Fuchs’ corneal dystrophy occurs when the endothelial cells are gradually lost over the years.

At first, a person with Fuchs’ corneal dystrophy may awaken with blurry vision that gradually clears later in the morning or by noon. The reason for this is during sleep the closed eyelids prevent evaporation; once the patient awakens, the open eyelids allow corneal surface evaporation to occur, allowing the cornea to thin and vision to improve. As the disease progresses, corneal swelling will remain constant and vision remains poor throughout the day.

Eventually, the epithelium also swells with fluid and may form tiny blisters, causing eye irritation, foreign body sensation and severe visual impairment. If these blisters burst they can cause severe pain.

To treat the disease, your doctor may initially try to reduce corneal swelling with hypertonic salt drops or ointment which extracts the fluid from the cornea. If the condition becomes painful, bandage soft contact lenses may be implemented. In early stages of this condition, a hair dryer held at arm’s length and directed parallel to face and be used to temporarily dry and thin the cornea. This easy procedure may temporarily improve symptoms and can be repeated several times a day.

Once the disease interferes with daily activities because visual performance is reduced and/or persistent pain occurs, your doctor may recommend corneal transplantation to restore sight and eliminate discomfort.

The Diseased Cornea – Corneal Transplantation

Corneal Transplantation may be necessary if your cornea is damaged due to injury or disease. Since there is no artificial substitute for corneal tissue, a human donor cornea is transplanted to restore sight. The Central Ohio Lions Eye Bank typically provides the corneal tissue for our patients.

A successful Corneal Transplant requires special, ongoing care and attention on the part of both patient and physician. However, no other surgery has so much to offer when the cornea is deeply scarred or afflicted with disease.

“Don’t take your organs to heaven…heaven knows we need them here! “

Corneal Transplant Surgery would not be possible without the hundreds of thousands of generous donors and their families who have donated corneal tissue so that others may see. If you would like more information on becoming a donor, please contact the Central Ohio Lions Eye Bankat (614) 293-8114 or (800) 301-4960

Corneal Transplantation Variations

Dr. Erdey may recommend one of the following surgical variations of corneal transplantation at the time of your consultation:

• Penetrating Keratoplasty (PK)
• Descemet’s Stripping Endothelial Keratoplasty (DSEK)
• Deep Anterior Lamellar Keratoplasty (DALK)

Penetrating Keratoplasty (PK)

Penetrating Keratoplasty (PK) is a traditional full-thickness corneal transplant. This may be required in cases where the cornea is scarred, swollen or excessively thin (Keratoconus).

Return of best vision after standard full thickness corneal transplantation may take up to a year or more after the operation. It is dependent on how long it takes for the grafted cornea to begin functioning as a lens; it must become transparent and it must have a regular surface curve. These important characteristics permit light to properly bend (refract) as it passes through the cornea, bending further as it passes through the crystalline lens and comes to focus on the retina.

The newly grafted cornea, if successful, only takes a few weeks to become thin and transparent but far more time is usually required until light is properly refracted through it.

The healthy cornea is transparent because it does not contain the fine blood vessels (capillaries) present in other tissues of the body. However, this lack of blood supply has a downside when cornea graft wound-healing is required. The cornea takes years to heal as compared to a superficial wound in the skin of your arm, which heals in only about a week! For this reason cornea graft sutures must be left in place for a year or more while the cornea graft-host interface heals. The tension generated by the sutures within the cornea often cause distortion of the curvature of the graft, causing the refraction of the eye to shift unpredictably. If the cornea surface is regular, and the prescription of the other eye is not too different, it is sometimes possible to prescribe glasses during this early rehabilitation period but the prescription lenses may need to be periodically changed as the cornea heals.

Some patients may need to wait until the sutures can be removed (1 to 1.5yrs) before the final surface topography is apparent and then glasses are prescribed. However, if after suture removal, significant cornea graft distortion or warpage (irregular astigmatism) remains, spectacles will not help. Instead, hard contact lenses may be suggested, but fitting can be challenging and is not always successful.

Other individuals require laser vision correction to reduce inadequate graft curvature or imbalances between the prescriptions of both eyes to maximize optical visual rehabilitation.

Of course, a good visual outcome is also dependent on general eye health and requires the absence of other visually limiting conditions such as cataract, glaucoma, or macular degeneration.

Descemet’s Stripping Endothelial Keratoplasty (DSEK)

View: 10TV News Report

Descemet’s Stripping Endothelial Keratoplasty (DSEK) is a newer, cornea-sparing transplant procedure that is indicated for patients without corneal scarring and with disease limited to the inner corneal layer (endothelium) such as Fuchs’ Endothelial Dystrophyor Pseudophakic Bullous Keratopathy.

Only the inner cornea layer is transplanted, leaving the patient’s cornea mostly intact. Only a small scleral incision is made and few sutures are required. The cornea heals very quickly and is less susceptible to injury or rupture as compared to standard PK. Visual recovery is much faster since the cornea’s original curvature is essentially unchanged resulting in little refractive shift. In contrast, after standard PK, patients often experience large changes in the amount of nearsightedness, farsightedness, and astigmatism. In fact, Dr Erdey prefers DSEK and no longer recommends PK for suitable candidates with Fuchs’ Endothelial Dystrophy orPseudophakic Bullous Keratopathy.

Cornea after DSEK: Note partial thickness donor graft (arrow) applied to inner cornea surface. Cornea transparency is restored.

Deep Anterior Lamellar Keratoplasty (DALK)

Deep anterior lamellar keratoplasty (DALK) is a partial thickness graft that preserves the TWO inner most layers of the cornea: Descemet’s membrane and the endothelium.

The goal of the procedure is to retain the endothelial layer of the host. This layer keeps the cornea clear by removing fluid from the bulk of the cornea.

Retaining this layer greatly reduces the risk of potentially blinding Graft Rejection that can occur with PK. If the endothelial layer is normal, then it is worth preserving.

The most suitable candidates for this procedure generally include those with healthy cornea endothelium, no descemet’s membrane scarring and who have:

» Keratoconus, gas permeable hard contact lens intolerance and are poor candidates for INTACS
» cornea scarring restricted to the bowman’s membrane or stroma
» cornea surface irregularity (irregular astigmatism) who are intolerant of hard contact lenses
» complications from Radial Keratotomy (RK)
» infectious keratitis unresponsive to medication

Advantages:

» Closed eye surgery
» No chance of potentially blinding endothelial rejection because the recipients own descemet’s membrane and endothelial cell layer is retained
» Can potentially repeat DALK or perform PK if the results of the original procedure are not satisfactory

Disadvantages:

» Conversion to full thickness PK often required
» Irregular astigmatism less common than PK but still possible
» Potential for interface scarring and reduced visual clarity possible but not common.
» Technically challenging
» Significantly longer operative time
» Offered by very few cornea surgeons

Cornea Transplantation – Complications

As in any kind of surgery, many different complications can occur. One unique to corneal transplantation is rejection of the donated tissue. Corneal transplants are rejected five to 30 percent of the time and can occur any time after cornea transplantation. The rejected cornea clouds and vision deteriorates. The warning signs of cornea graft rejection are RSVP:

» Redness – graft rejection may be associated with a red eye
» Sensitivity – to light, any increase from your baseline
» Vision – decrease in vision, especially if foggy or cloudy
» Pain – discomfort, irritation or foreign body sensation

If YOU ARE EXPERIENCING ANY ONE OF THESE WARNING SIGNS, YOU MUST IMMEDIATELY CONTACT YOUR OPHTHALMOLOGIST AND SCHEDULE AN APPOINTMENT TO BE SEEN WITHIN 24hrs., EVEN IF MANY YEARS HAVE PASSED SINCE THE ORIGINAL CORNEA TRANSPLANT SURGERY!

Most rejections, if treated promptly, can be reversed with minimal injury.

All cornea transplant patients are required to download, print, read and keep the following document for future reference: cornea graft rejectionBe informed. Never discard this important document! If the transplanted cornea fails, the graft may be replaced with a new donor, usually with good results, but the overall rejection rates for repeated transplants are higher than for the first transplant. Other possible complications include:

» infection
» bleeding
» retina swelling or detachment
» glaucoma
» irregular astigmatism

All of these complications can usually be successfully treated. Vision may continue to improve up to a year or more after surgery. If the surgery is successful, other existing eye conditions, such as macular degeneration, glaucoma, or diabetic retinopathy, may limit vision after surgery. Even with such problems, a corneal transplant may still be worthwhile.

The Diseased Cornea – Research

Various Stem Cell Research projects may hold the promise of finding ways to stimulate corneal endothelial cell regeneration. This is the “holy grail” that could eventually eliminate cornea transplantation in cases of endothelial cell loss.Other research is dedicated to developing better artificial corneas or eventually regenerating entire living corneas for transplantation.

Keratoconus

This disorder – a progressive thinning of the cornea – is the most common corneal dystrophy in the United States, affecting one in every 2,000 or 136,000 people across all races. It typically begins during teen years and progresses at varying rates until stabilizing by age 40.

Keratoconus manifests when the central and inferior areas of the cornea thin and gradually bulge outward, forming a cone-like shape. This abnormal curvature changes the cornea’s refractive properties causing varying degrees of blurred vision and distortion of objects. Occasional tissue swelling may occur which can, in time, lead to sight-impairing cornea scarring.

Keratoconus -Traditional Treatment

The treatment for keratoconus occurs in stages, from spectacles to contact lens to surgery typically over many years. Visual quality can be restored with spectacle correction in mild cases but more advanced stages require rigid contact lenses. A proper contact lens fit is crucial to insure optimal vision and comfort. In time, the cornea may become so warped, that contact lenses may repeatedly fall out of the eye or cannot be tolerated because they are too uncomfortable to wear. Historically, cornea transplantation has proven to be a successful treatment option for those patients with late stage keratoconus. However, even after a transplant, glasses or contact lenses are usually required and visual rehabilitation may take many months to achieve. Although keratoconus rarely results in total blindness, 20% of all patients will eventually require a corneal transplant.

Keratoconus – Treatment with Intacs®

Intacs® are tiny (0.25mms thick) acrylic ring segments (see figure above).

Intacs® insertion animation

Intacs® are inserted between the layers of the cornea (see figure above).

Intacs® were originally designed and FDA approved in 1999 to correct mild nearsightedness (myopia). In July 2004 the FDA approved Intacs® for keratoconus under a Humanitarian Device Exemption. In patients with keratoconus, Intacs® are indicated to reduce myopia and astigmatism in those who are no longer able to achieve adequate vision with contact lenses or glasses. They are an effective way to manage the condition and restore functional acuity by helping to restore the natural shape of a cornea weakened by keratoconus. In a number of patients, Intacs® may delay or ultimately prevent the need for cornea transplantation.

Intacs® – Clinical Facts

Thousands of Keratoconus eyes have been treated successfully with Intacs®.

Intacs® inserted within cornea (see figure above).

Most patients have experienced better quality of life, improved visual quality and stabilization of the keratoconic condition. Considerable research has been collected on patients having undergone the surgery since 1997 as demonstrated by the following results:

SAFETY:

» Intacs® for keratoconus mirror the safety of FDA-approved Intacs® for Myopia.
» If required, Intacs® can be removed preserving the option for corneal transplantation.

STABILIZE VISION:

» Intacs® may restore functional vision by allowing the eye to be effectively corrected with contact lenses or glasses if needed. 
» Intacs® add structural integrity to the cornea without invading the optical zone. 
» Intacs® flatten and shift the cone centrally, restructuring the corneal architecture to a normal prolate shape (see corneal topography below).

INTACS® vs. CORNEA TRANSPLANT:

Intacs® placement may defer cornea transplantation, generally recognized as the final course-of-action. A cornea transplant procedure is straightforward but graft management is both time-consuming and challenging. Multiple potential early and long-term complications are possible including a 10-20% graft rejection rate. By comparison, there is no risk of rejection of Intacs®. Like a cornea transplant, Intacs® rings actually add structural integrity to the cornea. Visual recovery time with Intacs® (1 to 3 months) is much shorter than cornea transplantation (3 to 24 months). IMPROVE VISION:

71% gained 1 or more lines of Best Corrected Visual Acuity. 73% gained 2 or more lines in Uncorrected Visual Acuity. Eyes with worse preoperative acuity had greater improvements in postoperative acuity. Eyes with corneal scarring also showed improvement. If you believe you might be a candidate for Intacs® for Keratoconus contact us to schedule a consultation with Richard A Erdey, MD.

IMPORTANT: If you wear contact lenses, you MUST discontinue contact lens use for 2 to 3 weeks BEFORE your consultation. Failure to do so may produce poor examination results.

For more information on Intacs® for Keratoconus view the complete patient booklet.

Eyelid surgery can dramatically restore a more youthful, rested, and naturally alert appearance. Cosmetic eyelid surgeryinvolves the removal of loose skin folds and bagginess, and can be performed on the upper and lower eyelids. While eyelid surgery is useful for removing excess tissue, laser skin resurfacing tightens and rejuvenates damaged skin. In this procedure, a high energy beam of light is applied to the skin, vaporizing unwanted tissue and smoothing surface indentations in quick, intense bursts. Laser skin resurfacing can even be used after eyelid surgery or a facelift to eliminate remaining lines. In each case, the number and duration of laser skin resurfacing sessions varies depending on the specific condition being treated.

Treatable conditions with laser skin resurfacing include

» Facial lines and wrinkles due to aging
» Crows feet at the corner of the eyes
» Lines and wrinkles under the eyes
» Laugh or “frown” creases
» Lines and wrinkles around the mouth
» Scars from acne, chicken pox, trauma or some surgeries

When excess skin or lid droop is enough to constrict vision, there may be a medical indication for repair. This is generally not considered cosmetic, and medical insurance will usually cover surgery under such circumstances. The improvement in appearance and visual performance afterward is often remarkable.

View Testimonials

We are also pleased to offer the innovation of cosmetic and functional radiofrequency eyelid surgery. This technique involves a no-pressure, sterile incision performed with ultrahigh frequency radiowaves. These radiofrequency waves produce minimal bruising as blood vessels are sealed while tissue is incised. The result is an efficient procedure with minimal recovery time.

Contact us for a complementary consultation.
Payment plans provided.