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Procedures & Services

Blepharoplasty

In today’s world of cosmetic surgery there is one procedure that’s ranked fifth as being the most popular surgery in the world. In fact, over hundred thousand men and women in the United States undergo this procedure yearly. Blepharoplasty is often performed as an elective surgery for cosmetic reasons. Since drooping or sagging eyelids can often make one appear older, this surgery reduces or eliminates the excess skin, muscle and fat, as well as removes puffiness and bags under the eyes. Blepharoplasty can turn worn and tired looking eyes into bright, younger, more alert looking eyes.

As wonderful as this procedure can be for cosmetic reasons, sometimes Blepharoplasty is needed for functional reasons. Blepharoplasty can be performed to improve vision if the upper skin folds interfere with normal vision. Did you know that the thinnest skin of the body is one's eyelid skin? As we age, our eyelids slowly stretch causing the muscles that support them to weaken. As a result, the skin may protrude over the eyelashes causing a loss of peripheral or side vision. Something as simple as reading, looking up or even driving a car may become a difficult task.

When Blepharoplasty is done purely for cosmetic reasons, it is not an insurance covered procedure. If one’s vision is impaired insurance may cover it.

If you or someone you know has vision loss due to loose skin interfering with one’s vision, one of our surgeons at MECA would be happy to have a consultation to determine if Blepharoplasty is right for you.

Comprehensive Eye Exams

MECA's ophthalmologists use many procedures and tests to evaluate the health and condition of the patient's eyes. These include testing of vision with an eye chart, measurements for glasses, and examination of the front and back portions of the eye with special microscopes. During our exams we evaluate all patients for the need for glasses and the presence of sight threatening eye diseases such as cataracts, corneal disease, glaucoma, diabetic retinopathy and macular degeneration. Many of these diseases do not cause any visual symptoms before vision loss occurs. Regular and thorough eye exams conducted by qualified and experienced ophthalmologists are essential for establishing and maintaining healthy eyes.

Exams may include a:

  • Visual acuity or refraction test to determine the degree to which you may be nearsighted, farsighted or have astigmatism. The refraction is also an important tool to determine your best corrected visual acuity and discover any presence of eye disease
  • Intraocular Eye Pressure is important in the diagnosis of Glaucoma or intraocular hypertension
  • Muscle function test to check the movement of your eyes in each direction and at specified angles. This test will identify any muscle weakness or involuntary eye movement.
  • Binocular vision skills assessment to ensure that your eyes work together properly as a team. This is important for proper depth perception, eye muscle coordination and the ability to change focus from near to far objects.
  • Visual field test to measure your peripheral vision, the width of the area you can see when you are looking straight ahead. This test may also detect diseases of the eyes or neurological disorders.
  • Retinal tests to screen or document macular degeneration, glaucoma, diabetic changes
  • Examination of the anterior and posterior segments of the eye by the physician. Dilation is needed for optimum view.

Corneal Transplants

The cornea is the clear tissue at the front of the eye in front of the iris. It allows light to enter the eye in order to focus on the retina. Many factors help keep this tissue clear and healthy. Eye disease, injury, infection and inflammation can cause the cornea to become cloudy or scarred.

Corneal transplant or keratoplasty surgery has evolved over the years and has been a safe and reliable treatment for corneal opacities. Corneal tissue is obtained from a donor cornea and is precisely cut to replace the patient’s damaged cornea.

There are several variations of corneal transplantations:

  • A full thickness corneal transplant, the cornea is completely removed and replaced with a donor cornea
  • Other corneal problems may only need a portion of the cornea replaced
  • Patients with corneal dystrophy or Fuch’s dystrophy may benefit from DSAEK or DSEK – descemet stripping endothelial keratoplasty. The back layer of the cornea, descemet membrane, is peeled and the same layer is obtained from the donor cornea for replacement.
  • Severe corneal scarring may not support a transplant and a keratoprosthesis may be needed. This precise plastic device is sewn into the scarred cornea and has a lens built in to focus the light rays.

Close follow-up with your physician as well as compliance with post-operative drops and medications is important for successful surgery.

Without the generosity of the many donors, this sight saving surgery could not be performed.

Diabetes and Diabetic Retinopathy

Diabetes is a disease that affects all areas of the body. Approximately 17 million Americans have diabetes, yet half are not aware they have the disease.

Diabetics should pay careful attention to their eyes as high blood sugar levels can damage blood vessels in the retina and are twice as likely to experience cataracts or glaucoma. The longer someone has diabetes, the more likely they will develop diabetic retinopathy.

  • Background Retinopathy (NPDR) – this is the early stage of diabetic retinopathy and tiny blood vessels leak and cause the retina to swell or form exudates which does not usually affect vision.
  • Macular Edema – this occurs when the damaged blood vessels leak fluid and lipids onto the macula - the part of the retina that lets one see detail. The fluid makes the macula swell, blurring vision. If new blood vessels have grown on the surface of the retina, they can bleed into the eye, blocking vision.
  • Proliferative Retinopathy (PDR) – this is the later stage of diabetic retinopathy, when abnormal new vessels being to grow on the surface of the retina. These new vessels are weak, break easily and cause bleeding, scarring and retinal detachments resulting in severe visual loss.

The treatment for Diabetic Retinopathy may be laser surgery for the edema and abnormal blood vessels. A vitrectomy may be needed in advance PDR to remove a vitreous hemorrhage, abnormal vessels, or to repair a retinal detachment. Surgery cannot restore vision that has already been lost to retinopathy, but it can reduce the risk of severe vision loss.

Since early detection and treatment are vital to preserving a diabetic's vision, it is extremely important that diabetics monitor their blood sugar and undergo regular eye exams with their ophthalmologist.

Dry Eye Syndrome

Dry Eye Syndrome (DES) is a lack of sufficient lubrication and moisture on the eye surface.  This may be caused by an insufficient quality and/or quantity of natural tears. Tears function as a lubricant, nutrition source, and “germ fighter” for the eyes. Symptoms of DES may include burning, redness, itching, foreign body sensation (sandy or gritty), and a general sense of dryness.  The level of discomfort ranges from very mild to very uncomfortable or even painful.  Tears are produced by the tear glands in the upper eyelids.  As they are secreted from the tear glands, they flow across the eye surface and are distributed by the blinking action of the lids.  Some of the tears evaporate and others drain away from the eye via the tear ducts.  An adequate oil layer on the tear film helps prevent rapid evaporation. 

There are multiple factors in the development of DES.  The eye becomes more dry as we get older due to the natural aging process.  Medications such as antihistamines, antidepressants and others also cause the eyes to become more dry.  Systemic diseases such as lupus, rheumatoid arthritis, rosacea or Sjogren’s syndrome are other causes of DES.  Long term contact lens wearers frequently suffer from DES.  Often persons will feel that they must discontinue contact lens wear due to the discomfort associated with their dry eyes. Of course if a person lives or works in a dry, dusty environment or climate, this will affect the severity of symptoms associated with DES.

Also, eyelid disease and incomplete closure of the eyelids contribute to DES.  Women are more likely than men to have dry eye symptoms possibly due to hormone fluctuations.

Eye surgery contributes to dry eye syndrome, especially LASIK surgery.   When  the corneal flap is created in LASIK, the corneal nerves are severed.  This prevents the “message” that the eyes are dry from being transmitted to the brain; therefore, tears are not produced in sufficient quantities to keep the eyes well lubricated and healthy.  In cataract surgery, there is a disruption of the nerve fibers at the incision site as well as exposure of the cornea allowing some evaporation of tears to occur despite the use of  drops and gel during the surgical procedure.  All surgery patients are instructed to use artificial tear drops and artificial tear gel for an extended time period postoperatively.

There are various treatment modalities to treat DES.  The first line of defense is to use artificial tears in drop and/or gel forms.  Nutritional supplements, specifically omega three fatty acids, taken by mouth may be used in conjunction with drops.  For additional therapies, punctual occlusion (punctum plugs or cautery) may be advised and prescription medications, as well as the use of cool mist humidifiers may be recommended by the doctor.

LipiFlow® from Tear Science
New Treatment Option for Evaporative Dry Eye

LipiFlow is a new procedure designed to treat blocked meibomian glands, MGD. These glands, located in your lids, produce the lipid layer of the tears. If your meibomian glands are blocked, the watery layer of the tears will evaporate causing dry eyes. Opening and clearing these blocked glands can allow them to resume natural production of lipids needed for a healthy tear film.

Click on these websites for additional therapies about dry eyes:    

Glaucoma

Glaucoma is a progressive condition where the internal pressure in the eye increases, causing damage to the optic nerve fibers that can result in permanent loss of vision. Glaucoma is a leading cause of blindness and visual impairment in the United States today, affecting over two percent of the population over the age of 35. Individuals who are especially at high risk for glaucoma include: individuals with a family history of glaucoma; African Americans; diabetics and individuals who are very nearsighted or have had a previous eye injury.

In patients with glaucoma, the intraocular pressure which represents the pressure inside the eye becomes abnormally high. In a normal eye, fluid flows constantly in and out of the anterior chamber, keeping the intraocular pressure at a normal level. In an eye with glaucoma, the passages that normally allow the fluid to drain become blocked. No one is sure why this happens, but unless the pressure is controlled, permanent vision loss occurs.

Narrow or Closed Angle Glaucoma

This type of glaucoma occurs when the mechanism of draining the eye fluid cannot keep up with the production. The iris may sit too close to the draining angle and block the fluid from draining. The eye pressure can build rapidly and immediate attention is needed. Symptoms include blurred vision, severe pain, headache, halos around lights and redness of the eye. This condition requires immediate attention from your ophthalmologist. Blindness can result if it is not treated immediately.

Chronic Open Angle Glaucoma

This is the most common type of glaucoma. It develops gradually and there are no symptoms. That is why eye physicians refer to this condition as "The Silent Thief of Sight". Most people are not aware that they have the disease.

Early detection of the disease is essential. It can only be achieved through comprehensive annual eye examinations. Several tests are performed to measure the pressure of the eye, and evaluate the health of the optic nerve. If the optic nerve is found to be damaged and/or the pressure inside the eye is found to be elevated, glaucoma is then suspected and additional tests are performed to confirm the diagnosis. A Visual Field Test will assess any changes in the central and side vision. Without treatment, glaucoma will continue to progress and eventually cause blindness. However, appropriate treatment can lower the pressure inside the eye, control the glaucoma and prevent any loss of vision. For most people, the treatment will consist of special eye drops used on a daily basis. Regular follow-up visits will insure that the pressure of the eye is under control and no additional damage to the optic nerve has occurred.

Laser trabeculoplasty (SLT) uses a special laser beam to selectively open the drainage passageways within the trabecular meshwork (the area responsible for draining the fluid from the eye). In more advanced cases, surgery might be necessary to create a new drain to filter the excess fluid out of the eye.

The eye physicians at MECA routinely check the health of the optic nerve and the intraocular pressure to detect any abnormal changes. If glaucoma is suspected, visual fields will be performed and medical treatment will be started. If the intraocular pressure cannot be controlled with eye drops or if the damage is extensive, appropriate surgical intervention may be recommended to avoid the progression of glaucoma.

Macular Degeneration


Amsler Grid
Please click here for printable copy and
instructions for use.

Age-Related Macular Degeneration (ARMD) is a common eye disease that affects a tiny area in the center of the retina known as the macula. The retina is the nerve layer at the back of the eye that transmits images from light to the brain. The macula is made up of millions of light-sensing cells that produce the sharp central vision. ARMD breaks down these cells, gradually destroying central vision.

It is estimated that over 13 million Americans over the age of 40 show early signs of ARMD, and it is the leading cause of legal blindness and vision impairment in the senior population. Smokers, people with light colored eyes, and individuals with a family history of ARMD are more at risk for developing this condition.

ARMD is detected during a comprehensive eye examination during which your eye doctor will examine the health of your retina. Once detected, your doctor may recommend additional testing. The most common test is called a “Fluorescein Angiography”. A special dye is injected into the vein and pictures are taken of the dye traveling through the retina in the back of the eye. This test is used to assess the type of the disease, monitor progression and determine treatment. The newest technology for ARMD at MECA is the OCT (Optical Coherence Tomography) Imaging, which gives us a cross-sectional image of the retina and macula. This allows us to even better assess any potential macular or retinal disease.

With ARMD, the central vision decreases. The side vision is almost never affected. In other words, macular degeneration carries good news and bad news. The good news is that people diagnosed with this disease almost never go completely blind. The bad news is that when the central vision is severely affected, the driving vision and more importantly the reading vision become limited.

Macular degeneration occurs in two forms: Dry and Wet:

Dry Age-Related Macular Degeneration

Ninety percent (90%) of individuals diagnosed with ARMD have the dry form. The light sensitive cells in the macula slowly break down affecting central vision over time. Dry ARMD often occurs in just one eye at first, and slowly progresses with time to involve the second eye.

The most common symptom of dry ARMD is slightly blurred vision. Dry ARMD develops very slowly over many years and most people are able to lead normal, active lives, especially if the disease affects only one eye. As the disease progresses, a blurred spot forms in the center of the vision, gradually becoming larger and darker, reducing central vision.

Currently, there is no treatment for dry ARMD. Recent studies have revealed that vitamins rich in anti-oxidants, such as Vitamin C, Vitamin E, Zinc and Lutein, decrease the incidence of dry ARMD and can limit its progression. These vitamins can be safely taken in addition to the regular daily multivitamin therapy.

There are a number of common health risks that are closely linked with macular degeneration. These risks can be avoided by stopping smoking, controlling cholesterol and blood pressure, protecting the eyes from ultraviolet (UV) rays, and making sure that the diet is high in fruits and green, leafy vegetables.

Wet Age-Related Macular Degeneration

Although only ten percent (10%) of all people with ARMD have this type, it accounts for 90 percent of all blindness. New blood vessels behind the retina begin to grow toward the macula. These vessels are very fragile and often leak blood and fluid under the macula rapidly causing the damage that leads to loss of central vision.

All patients with ARMD should monitor their vision with an Amsler grid which can help detect the early signs of ARMD. In wet ARMD, straight lines can take on a "curved" or "wavy" appearance and the Amsler grid helps detect this change.

Now, more than ever before, early detection of the conversion of dry ARMD into wet ARMD is important as the treatment for wet ARMD has improved greatly in recent years. The new treatments for ARMD consist of intraocular injections to inhibit and cause regression of ARMD.

The eye physicians at MECA routinely check the retina looking for the slightest signs of Age-related Macular Degeneration. If it is suspected, thorough testing will be performed to evaluate the extent of the damage and establish a course of action. Our eye surgeons are highly experienced in medical and laser treatment of the retina.

Ocular Surface Reconstruction and Limbal Stem Cell Transplantation

A wide variety of factors can negatively impact the surface of the eyes, compromising vision, comfort, and the ability to combat infection. Corneal eye diseases may cause blurry vision, loss of vision, ocular surface scarring and other uncomfortable forms of corneal damage. Limbal stem cells are necessary for the maintenance of a clear cornea. When these cells are damaged, traditional corneal transplants invariably fail. Once healthy limbal stem cells are transplanted, a traditional corneal transplant can be performed.

Certain conditions or diseases can cause limbal stem cells to malfunction or even destroy them. These include chemical burns, Stevens - Johnson syndrome, ocular cicatricial pemphigoid and other inflammatory diseases of the surface of the eye. If the stem cells are damaged, the eye can no longer heal its surface.

A healthy eye can readily renew itself by using stem cells for regeneration. Ocular surface reconstruction is a surgical method that is used to treat this condition, and includes the use of amniotic membranes and/or limbal stem cell transplantation. MECA surgeons have had special training in using a wide array of techniques and treatments such as medication, surgery, and transplantation to rebuild or restore the eye’s surface.

We look forward to helping these challenging patients improve their vision and restore both the function and appearance of the surface of the eye.