Healthy Eyes 101

On this episode Dr. George Chioran and Dr. Steven Suh answer the most common patient questions that are asked about cataracts and cataract surgery. 

• What is a cataract and why do they occur? 
• What symptoms do people with cataracts have? 
• What are some other options before proceeding with surgery? 
• How do the surgeon and the patient decide when the time is right for surgery? 
• What do you tell patients who are going to have cataract surgery? 
• Does insurance cover surgery?  
• What are the risks of surgery? Can I go blind from cataract surgery?
• What other things are needed before surgery?  
• How is the cataract removed? Do you use a laser? 
• Can you do cataract surgery on both eyes on the same day? 
• What should patients expect at the surgery center or hospital? 
• What is the intraocular lens implant made of? 
• What are the different types of lens implants available? 
• What should patients expect the day after surgery? 
• What post-op care is necessary?  How many post-op visits? 
• What restrictions are there afterwards? Do I wear a patch or shield? 
• Do cataracts ever come back? 
• Will the lens implants last forever? 
• What kind of issues may arise after surgery? 
• Will my vision change in the future? 

Here is a great link on cataracts and cataract surgery.

If you would like to see an actual cataract surgery narrated by Dr. Suh, please watch this video.

To find out more about Dr. Chioran and Dr. Suh’s practice, go to Comprehensive EyeCare of Central Ohio’s website or Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

On this episode Dr. George Chioran and Dr. Steven Suh answer the most common patient questions that are asked about cataracts and cataract surgery. 

• What is a cataract and why do they occur? 
• What symptoms do people with cataracts have? 
• What are some other options before proceeding with surgery? 
• How do the surgeon and the patient decide when the time is right for surgery? 
• What do you tell patients who are going to have cataract surgery? 
• Does insurance cover surgery?  
• What are the risks of surgery? Can I go blind from cataract surgery?
• What other things are needed before surgery?  
• How is the cataract removed? Do you use a laser? 
• Can you do cataract surgery on both eyes on the same day? 
• What should patients expect at the surgery center or hospital? 
• What is the intraocular lens implant made of? 
• What are the different types of lens implants available? 
• What should patients expect the day after surgery? 
• What post-op care is necessary?  How many post-op visits? 
• What restrictions are there afterwards? Do I wear a patch or shield? 
• Do cataracts ever come back? 
• Will the lens implants last forever? 
• What kind of issues may arise after surgery? 
• Will my vision change in the future? 

Here is a great link on cataracts and cataract surgery.

If you would like to see an actual cataract surgery narrated by Dr. Suh, please watch this video.

To find out more about Dr. Chioran and Dr. Suh’s practice, go to Comprehensive EyeCare of Central Ohio’s website or Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Dr. Ashley San Filippo returns to the Healthy Eyes 101 podcast to discuss MIGS (Minimally Invasive Glaucoma Surgery), a relatively new category of glaucoma procedures that have advantages over traditional glaucoma surgeries.

Lowering eye pressure is the major goal of glaucoma treatment since this disease is not curable. Medicated eye drops, laser surgery, and traditional surgery are various ways to treat glaucoma. If patients are on maximum medical therapy with continued progression of their glaucoma, cannot tolerate the drops, or are non-compliant with taking their drops, then laser or surgical intervention may be necessary. 

MIGS has given patients a new avenue of treatment that has a much quicker post-operative recovery than traditional glaucoma surgery. While most MIGS are indicated to lower eye pressure in mild-to-moderate stages of glaucoma, their safety profile is favorable to trabeculectomies and glaucoma drainage implants. MIGS work by increasing outflow of the normal eye fluid or decreasing the production of the fluid. In the United States, most of the MIGS procedures have to performed in conjunction with cataract surgery.  

Trabecular bypass procedures

• iStent and iStent Inject 
• Hydrus 

Trabecular tissue incision/excision procedures

• Kahook Dual Blade goniotomy 
• Trabectome 
• Trab 360/OMNI
• Gonioscopy-Assisted Transluminal Trabeculotomy

Laser endocyclophotocoagulation 

Here is some more information on MIGS:

• https://www.glaucoma.org/treatment/migs-the-new-age-of-glaucoma-surgery.php
• https://www.glaucoma.org/treatment/what-is-migs.php

Scroll down to the MIGS video on Dr. San Filippo’s glaucoma page to watch her explain iStent on a local news show. 

To find out more about Dr. San Filippo, go to her website or follow her practice on Facebook, Instagram, and Twitter. 

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Dr. Ashley San Filippo returns to the Healthy Eyes 101 podcast to discuss MIGS (Minimally Invasive Glaucoma Surgery), a relatively new category of glaucoma procedures that have advantages over traditional glaucoma surgeries.

Lowering eye pressure is the major goal of glaucoma treatment since this disease is not curable. Medicated eye drops, laser surgery, and traditional surgery are various ways to treat glaucoma. If patients are on maximum medical therapy with continued progression of their glaucoma, cannot tolerate the drops, or are non-compliant with taking their drops, then laser or surgical intervention may be necessary. 

MIGS has given patients a new avenue of treatment that has a much quicker post-operative recovery than traditional glaucoma surgery. While most MIGS are indicated to lower eye pressure in mild-to-moderate stages of glaucoma, their safety profile is favorable to trabeculectomies and glaucoma drainage implants. MIGS work by increasing outflow of the normal eye fluid or decreasing the production of the fluid. In the United States, most of the MIGS procedures have to performed in conjunction with cataract surgery.  

Trabecular bypass procedures

• iStent and iStent Inject 
• Hydrus 

Trabecular tissue incision/excision procedures

• Kahook Dual Blade goniotomy 
• Trabectome 
• Trab 360/OMNI
• Gonioscopy-Assisted Transluminal Trabeculotomy

Laser endocyclophotocoagulation 

Here is some more information on MIGS:

• https://www.glaucoma.org/treatment/migs-the-new-age-of-glaucoma-surgery.php
• https://www.glaucoma.org/treatment/what-is-migs.php

Scroll down to the MIGS video on Dr. San Filippo’s glaucoma page to watch her explain iStent on a local news show. 

To find out more about Dr. San Filippo, go to her website or follow her practice on Facebook, Instagram, and Twitter. 

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

In this episode Dr. Suh interviews Dr. Chirag Patel,  a retina specialist, about two conditions that can affect central vision - macula puckers and macular holes. 

Patients with a macular pucker (also called epiretinal membrane, epimacular membrane, cellophane maculopathy, and surface wrinkling retinopathy) will have symptoms of distortion or blurred vision that does not go away. A pseudohole is a variant of a macular pucker that looks like a macular hole.

The majority of puckers occur spontaneously and without a cause (idiopathic). Secondary causes make up around 10-20% of cases and can be from from diabetic retinopathy, retinal vein occlusions, retinal tears and detachments, and trauma. After the age of 50, 2% of the population may have a macular pucker while 20% of people over 75 may have one. If there is a secondary reason for the pucker, this can occur at any age.

Macular holes will also cause symptoms of blurring and distortion. The patient may also notice a missing area in the center of their vision. The cause of macular holes is probably related to the vitreous gel tugging on the macular region. This traction can pull off the center part of the macula and leave a hole. Macular holes can also occur after ocular trauma. People over 60 are more likely to have a spontaneous macular hole. Females are more prone to have them than males, unlike with puckers where females and males have about the same incidence.

Diagnosis of both of these conditions can be done by direct examination of the macula and by OCT (optical coherence tomography). Patients with macular issues should monitor their vision with an Amsler grid to look for distortion or missing areas. 

Medications and lasers cannot be used to treat either condition. Surgery is the only treatment. Macular pucker surgery is only performed if the patient has bothersome visual symptoms. Patients with macular holes should have surgery when the retina specialist recommends it. Visual recovery after these surgeries may be slow, and patients may not recover 20/20 vision afterwards. The surgery should improve the distortion or the missing area in the center.

The Retina Group, Dr. Patel’s practice, has excellent resources and surgical videos about macular puckers (epiretinal membranes) and macular holes on its website.

Here are some other websites for more information on macular puckers and macular holes. 

Learn more about Dr. Patel and his practice at their website and Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

In this episode Dr. Suh interviews Dr. Chirag Patel,  a retina specialist, about two conditions that can affect central vision - macula puckers and macular holes. 

Patients with a macular pucker (also called epiretinal membrane, epimacular membrane, cellophane maculopathy, and surface wrinkling retinopathy) will have symptoms of distortion or blurred vision that does not go away. A pseudohole is a variant of a macular pucker that looks like a macular hole.

The majority of puckers occur spontaneously and without a cause (idiopathic). Secondary causes make up around 10-20% of cases and can be from from diabetic retinopathy, retinal vein occlusions, retinal tears and detachments, and trauma. After the age of 50, 2% of the population may have a macular pucker while 20% of people over 75 may have one. If there is a secondary reason for the pucker, this can occur at any age.

Macular holes will also cause symptoms of blurring and distortion. The patient may also notice a missing area in the center of their vision. The cause of macular holes is probably related to the vitreous gel tugging on the macular region. This traction can pull off the center part of the macula and leave a hole. Macular holes can also occur after ocular trauma. People over 60 are more likely to have a spontaneous macular hole. Females are more prone to have them than males, unlike with puckers where females and males have about the same incidence.

Diagnosis of both of these conditions can be done by direct examination of the macula and by OCT (optical coherence tomography). Patients with macular issues should monitor their vision with an Amsler grid to look for distortion or missing areas. 

Medications and lasers cannot be used to treat either condition. Surgery is the only treatment. Macular pucker surgery is only performed if the patient has bothersome visual symptoms. Patients with macular holes should have surgery when the retina specialist recommends it. Visual recovery after these surgeries may be slow, and patients may not recover 20/20 vision afterwards. The surgery should improve the distortion or the missing area in the center.

The Retina Group, Dr. Patel’s practice, has excellent resources and surgical videos about macular puckers (epiretinal membranes) and macular holes on its website.

Here are some other websites for more information on macular puckers and macular holes. 

Learn more about Dr. Patel and his practice at their website and Facebook page.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Dr. Karl Pappa, a glaucoma specialist, joins Dr. Suh on this episode to discuss all aspects of glaucoma medications. Glaucoma, a disease of the optic nerve, is thought to be worsened by increased eye pressure. The goal of treatment, whether it be with eye drops, laser or surgery, is to lower the intraocular pressure (IOP).

Categories of Glaucoma Medications

• Prostaglandin analogs
  • Xalatan (latanoprost), Lumigan (bimatoprost), Travatan Z (travoprost), Zioptan (tafluprost), and Vyzulta (latanoprostene bunod)
  • How they lower pressure: increases the outflow of fluid
  • Dosing: once at bedtime
  • Main side effects: eye redness, iris color change, eyelash growth, darkening of eyelid skin
• Beta blockers
  • Timolol, Timoptic XE (gel-forming solution)
  • How they lower pressure: decreases production of fluid
  • Dosing: once or twice a day
  • Main side effects: low blood pressure, decreased pulse rate, fatigue, shortness of breath (in COPD and asthma patients), depression
• Alpha agonists
  • Alphagan P (brimonidine)
  • How they lower pressure: decreases production of fluid and increases drainage
  • Dosing: two or three times a day
  • Main side effects: allergy to the medication, fatigue/drowsiness, burning or stinging, headache, dry mouth
• Carbonic anhydrase inhibitors
  • Eye drops -Trusopt (dorzolamide), Azopt (brinzolamide)
  • Oral medications: Diamox (acetazolamide) and Neptazane (methazolamide)
  • How they lower pressure: decreases production of fluid
  • Dosing: twice a day for the drops; varies for the pills (follow instructions of your eye care specialist)
  • Main side effects: eye drops: stinging; pills: tingling of hands and feet, fatigue, stomach upset
• Rho kinase inhibitor
  • Rhopressa (netarsudil)
  • How they lower pressure: increases the outflow of fluid
  • Dosing: once at bedtime
  • Main side effects: eye redness, stinging, tiny hemorrhages on the white of the eye

Combination eye drops help with compliance and may be more economical. Examples include Cosopt (timolol/dorzolamide), Combigan (timolol/brimonidine), Simbrinza (brimonidine/brinzolamide), and Rocklatan (netarsudil/latanoprost).

One reason patients have decreased compliance is because they can get ocular surface irritation and dry eyes from repeated use of drops that contain preservatives such as benzalkonium chloride (BAK). Several preservative-free options include Zioptan, Cosopt PF, and Timoptic in Ocudose.

Several new drug delivery alternatives are being studied. The FDA recently approved Durysta (bimatoprost), a biodegradable sustained-release implant that is injected into the eye between the cornea and the iris. Obviously, compliance will not be an issue with this medicated implant but it will have to be replaced every few months.

After instilling a glaucoma drop into your eye, close your eyes for up to five minutes to maximize absorption into the eyes and minimize systemic absorption to avoid some of the side effects.

Here is another resource about glaucoma drops.

To learn more about Dr. Pappa and his practice, visit Arena Eye Surgeon's website or find the practice on Facebook.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Dr. Karl Pappa, a glaucoma specialist, joins Dr. Suh on this episode to discuss all aspects of glaucoma medications. Glaucoma, a disease of the optic nerve, is thought to be worsened by increased eye pressure. The goal of treatment, whether it be with eye drops, laser or surgery, is to lower the intraocular pressure (IOP).

Categories of Glaucoma Medications

• Prostaglandin analogs
  • Xalatan (latanoprost), Lumigan (bimatoprost), Travatan Z (travoprost), Zioptan (tafluprost), and Vyzulta (latanoprostene bunod)
  • How they lower pressure: increases the outflow of fluid
  • Dosing: once at bedtime
  • Main side effects: eye redness, iris color change, eyelash growth, darkening of eyelid skin
• Beta blockers
  • Timolol, Timoptic XE (gel-forming solution)
  • How they lower pressure: decreases production of fluid
  • Dosing: once or twice a day
  • Main side effects: low blood pressure, decreased pulse rate, fatigue, shortness of breath (in COPD and asthma patients), depression
• Alpha agonists
  • Alphagan P (brimonidine)
  • How they lower pressure: decreases production of fluid and increases drainage
  • Dosing: two or three times a day
  • Main side effects: allergy to the medication, fatigue/drowsiness, burning or stinging, headache, dry mouth
• Carbonic anhydrase inhibitors
  • Eye drops -Trusopt (dorzolamide), Azopt (brinzolamide)
  • Oral medications: Diamox (acetazolamide) and Neptazane (methazolamide)
  • How they lower pressure: decreases production of fluid
  • Dosing: twice a day for the drops; varies for the pills (follow instructions of your eye care specialist)
  • Main side effects: eye drops: stinging; pills: tingling of hands and feet, fatigue, stomach upset
• Rho kinase inhibitor
  • Rhopressa (netarsudil)
  • How they lower pressure: increases the outflow of fluid
  • Dosing: once at bedtime
  • Main side effects: eye redness, stinging, tiny hemorrhages on the white of the eye

Combination eye drops help with compliance and may be more economical. Examples include Cosopt (timolol/dorzolamide), Combigan (timolol/brimonidine), Simbrinza (brimonidine/brinzolamide), and Rocklatan (netarsudil/latanoprost).

One reason patients have decreased compliance is because they can get ocular surface irritation and dry eyes from repeated use of drops that contain preservatives such as benzalkonium chloride (BAK). Several preservative-free options include Zioptan, Cosopt PF, and Timoptic in Ocudose.

Several new drug delivery alternatives are being studied. The FDA recently approved Durysta (bimatoprost), a biodegradable sustained-release implant that is injected into the eye between the cornea and the iris. Obviously, compliance will not be an issue with this medicated implant but it will have to be replaced every few months.

After instilling a glaucoma drop into your eye, close your eyes for up to five minutes to maximize absorption into the eyes and minimize systemic absorption to avoid some of the side effects.

Here is another resource about glaucoma drops.

To learn more about Dr. Pappa and his practice, visit Arena Eye Surgeon's website or find the practice on Facebook.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Retina specialist, Dr. Dominic Buzzacco, joins Dr. Suh to talk about age-related macular degeneration (AMD), one of the most common causes of central vision loss in people over 50. People with early AMD will notice distortion, blurred vision, a blind spot, or, sometimes, nothing.

Risk factors include:

• Age over age 50
• Caucasian
• Smoking
• Family history (a first-degree relative increases the risk seven-fold)
• Light-colored irises
• Uncontrolled cardiovascular disease and high blood pressure

Dry (non-exudative) AMD is by far the most common type and may be associated with retinal pigmentary abnormalities and soft drusen, yellow deposits found under the retina. About 10% of dry AMD patients will progress to the wet form.

Wet (exudative or neovascular) AMD is characterized by the formation of abnormal blood vessels underneath the retina. These vessels may leak or bleed and cause scar tissue. Vision loss is more rapid with untreated wet AMD vs. the dry form.

All patients with AMD should monitor their vision in each eye individually on a regular basis by using an Amsler grid.

Patients with dry AMD should take AREDS 2 (Age-Related Eye Disease Study 2) vitamins to help slow down the progression of vision loss. Early diagnosis is important so that patients can be advised to start these eye vitamins. Patients who smoke should consider stopping.

Those with wet AMD will probably need to have intraocular injections of so-called anti-VEGF medications to slow down or stop the abnormal vessel growth. The injections may contain the medications Avastin (bevacizumab), Lucentis (ranibizumab), Eylea (aflibercept), or Beovu (brolucizumab). These injections are not a cure but can keep the leaking or bleeding under control. Most patients will need monthly injections until all fluid / bleeding is absorbed and there is no evidence of recurrence. Some may need injections every eight to twelve weeks indefinitely. These medications have been a huge leap forward to stabilizing the disease in 95% of people and improving vision in 30-40% of eyes.

Some risks of the injections include a subconjunctival hemorrhage (bruise) which goes away in a few days; temporary foreign body sensation; corneal abrasion; and intraocular infection (1:4000-5000 injections).

Most patients will never go completely blind from their AMD even if central vision deteriorates because their peripheral vision remains intact.

Some future treatments include a surgically implantable port (or reservoir) delivery system for injecting Lucentis. Gene therapy is also being studied to turn off the growth factors for abnormal blood vessels.

Unfortunately, some AMD patients may lose enough of their useful vision to perform daily activities. Low vision aids can help those with permanent vision loss. Services are available to assess the types of devices that patients may need to help them function better.

Here are some more resources on macular degeneration.
Article #1
Article #2

To find out more about Dr. Buzzacco and his practice, go to Midwest Retina’s website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.

Retina specialist, Dr. Dominic Buzzacco, joins Dr. Suh to talk about age-related macular degeneration (AMD), one of the most common causes of central vision loss in people over 50. People with early AMD will notice distortion, blurred vision, a blind spot, or, sometimes, nothing.

Risk factors include:

• Age over age 50
• Caucasian
• Smoking
• Family history (a first-degree relative increases the risk seven-fold)
• Light-colored irises
• Uncontrolled cardiovascular disease and high blood pressure

Dry (non-exudative) AMD is by far the most common type and may be associated with retinal pigmentary abnormalities and soft drusen, yellow deposits found under the retina. About 10% of dry AMD patients will progress to the wet form.

Wet (exudative or neovascular) AMD is characterized by the formation of abnormal blood vessels underneath the retina. These vessels may leak or bleed and cause scar tissue. Vision loss is more rapid with untreated wet AMD vs. the dry form.

All patients with AMD should monitor their vision in each eye individually on a regular basis by using an Amsler grid.

Patients with dry AMD should take AREDS 2 (Age-Related Eye Disease Study 2) vitamins to help slow down the progression of vision loss. Early diagnosis is important so that patients can be advised to start these eye vitamins. Patients who smoke should consider stopping.

Those with wet AMD will probably need to have intraocular injections of so-called anti-VEGF medications to slow down or stop the abnormal vessel growth. The injections may contain the medications Avastin (bevacizumab), Lucentis (ranibizumab), Eylea (aflibercept), or Beovu (brolucizumab). These injections are not a cure but can keep the leaking or bleeding under control. Most patients will need monthly injections until all fluid / bleeding is absorbed and there is no evidence of recurrence. Some may need injections every eight to twelve weeks indefinitely. These medications have been a huge leap forward to stabilizing the disease in 95% of people and improving vision in 30-40% of eyes.

Some risks of the injections include a subconjunctival hemorrhage (bruise) which goes away in a few days; temporary foreign body sensation; corneal abrasion; and intraocular infection (1:4000-5000 injections).

Most patients will never go completely blind from their AMD even if central vision deteriorates because their peripheral vision remains intact.

Some future treatments include a surgically implantable port (or reservoir) delivery system for injecting Lucentis. Gene therapy is also being studied to turn off the growth factors for abnormal blood vessels.

Unfortunately, some AMD patients may lose enough of their useful vision to perform daily activities. Low vision aids can help those with permanent vision loss. Services are available to assess the types of devices that patients may need to help them function better.

Here are some more resources on macular degeneration.
Article #1
Article #2

To find out more about Dr. Buzzacco and his practice, go to Midwest Retina’s website.

This is intended for informational and educational purposes only, and nothing in this podcast/blog is to be considered as recommending or rendering medical advice or treatment to a specific patient. Please consult your eye care specialist for proper diagnosis and treatment of any eye conditions that you may have.