Cape Fear Cataract & Cornea, P.A.

Cape Fear Cataract

• Cataract Surgery

  WHAT ARE CATARACTS? At the front of each eye, there is a lens that light passes through. As we age and proteins in the eye begin to deteriorate, tiny protein particles may clump together on the lens of one or both eyes. As a result of protein accumulation, the lens becomes cloudy. The clouding on the lens is what we refer to as cataracts. SYMPTOMS OF CATARACTS In early stages, a cataract may simply cause simple blurring and a need to change spectacles. Eventually, however, patients with cataract experience painless and progressive reduction of sight resulting in significant visual handicaps. The most common way that vision is affected is that objects appear cloudy as if you were looking through a dirty window. Additionally, cataracts may cause: Diminished vibrancy; colors do not appear as bright as they once did Difficulty seeing in low light or at night Sensitivity to bright light and sunshine Blurry or double vision HOW ARE CATARACTS TREATED? Cataract surgery is the only treatment for visually significant cataracts and is recommended when a reduction in vision significantly impacts daily functions. Happily, modern cataract surgery at Cape Fear Cataract & Cornea, P.A. is a painless outpatient procedure which restores vision and can also reduce or eliminate dependence on glasses. During surgery, Dr. Groat removes the clouded lens and replaces it with an ultra-thin synthetic lens. Cataract surgery is one of the most common ophthalmic procedures performed. The treatment takes only a few minutes and often results in better vision than existed before cataracts developed. Patients may have astigmatism, nearsightedness, farsightedness, and even presbyopia (the need for reading glasses) treated simultaneously at the time of cataract surgery. Talk with Dr. Groat about your vision goals during your consultation and receive the assistance you need to select the ideal IOL for your needs. WHY YOU SHOULD CHOOSE DR. GROAT FOR YOUR CATARACT SURGERY Dr. Groat is an expert cataract surgeon who employs superlative experience and all the latest technologies available to provide you with the best cataract treatment available anywhere. See what some of his patients say about their treatment with Dr. Groat: WHO IS A CANDIDATE FOR CATARACT SURGERY? Most healthy adults who wish to restore clear vision can be good candidates for cataract surgery. Dr. Brian Groat will conduct a comprehensive eye exam and will review any medical history with each patient to ensure there are no coexisting conditions that could diminish the safety or efficacy of cataract removal. CATARACT SURGERY OPTIONS When we discuss options for cataract surgery, we are usually focusing on the type of artificial lens that will be implanted into the eye during the procedure. Artificial lenses, called intraocular lenses or IOLs, are made of silicone or acrylic. A variety of implant types are available today. Each is categorized as either a standard IOL or a premium IOL. During the treatment-planning process, we work alongside the patient to help them determine which type of lens would best suit their needs. Standard IOLs are made to correct one range of vision, near or distance. Therefore, patients who choose this type of artificial lens may continue to need eyeglasses for certain tasks. For example, if you choose a standard IOL with a distance prescription, you may need reading glasses to see up close. Premium IOLs accommodate both near and distance vision by working with the natural functions of the eye in some way. Patients who are interested in reducing or eliminating their need for eyeglasses after cataract removal often choose this type of lens implant. ARE THE RESULTS AFTER CATARACT SURGERY PERMANENT? Yes. Artificial lenses made of silicone or acrylic are made to last indefinitely. However, the new lens could be disrupted or damaged in the event of injury to the eye. SCHEDULE A CONSULTATION WITH DR. BRIAN GROAT When you need surgery, you can trust Cape Fear Cataract & Cornea, P.A. to develop the best customized surgical plan for you after discussing your needs and options. Call us at (910) 769-4590 to schedule your consultation today.

  Link: Cataract Surgery

• Cornea Transplant

  The cornea is the clear covering on the front of the eye. It accounts for a large part of your eye’s focusing power. Light enters the eye through the cornea and is refracted back onto the retina in the back of the eye. The retina then sends signals to the brain through the optic nerve and the brain interprets what a person is seeing. For clear, accurate vision, the cornea needs to be correctly shaped and free from clouding. Then incoming light rays can be focused precisely. But the cornea can become misshapen or cloudy from injury, infection, or eye disease, and it may need to be replaced. These transplants may replace the entire cornea or only the damaged portion of it. Dr. Brian Groat performs corneal transplants at Cape Fear Cataract & Cornea in Willmington, NC. WHAT IS A CORNEAL TRANSPLANT? A corneal transplant is a surgical procedure that replaces all or part of your damaged cornea with donor corneal tissue. Corneal transplants can be categorized as “full-thickness” or “back layer.” The goal is to replace damaged or diseased corneal tissue that is impacting the patient’s vision beyond what can be corrected with eyeglasses or contact lenses. WHY WOULD A PERSON NEED A CORNEAL TRANSPLANT? Corneal eye disease affects over 10 million people worldwide; it is the fourth most common cause of blindness. When disease or injury damages the cornea, it can become swollen, scarred, or severely misshapen, and this distorts the quality of the person’s vision. In these cases, eyeglasses or contact lenses are used as the first treatment options. But when these can no longer provide the degree of correction needed, a corneal transplant could become necessary. In other cases, swelling can become so painful that a transplant is the only route forward. WHAT IS THE SUCCESS RATE FOR CORNEAL TRANSPLANTS? Success rates of corneal transplants are very high and continue to increase with new techniques and better eye bank protocols. If the patient can avoid rejection (or at least see the signs to reverse it early), success rates for this surgery are around 90 percent. It is one of the most successful of all tissue transplants in the body. HOW WILL MY VISION BE AFTER A CORNEAL TRANSPLANT? Most patients have their vision at least partially restored. Your overall health can affect the quality of your vision. Corneal rejection continues to be a potential risk for years after your surgery, but this can be managed with medications. Once your cornea has fully healed, Dr. Groat can make some adjustments to improve your vision. In full-thickness transplants, the stitches that hold the donor cornea in place can create dips and bumps in your cornea. This is similar to astigmatism, so some stitches may be released and others tightened to remove these bumps. Refractive errors can be corrected with eyeglasses, contact lenses, or, in some cases, laser eye surgery. RISKS & SIDE EFFECTS OF A CORNEA TRANSPLANT The biggest risk with these procedures is that your body will reject the donor cornea. This occurs in nearly a third of corneal transplant patients. It occurs when your body believes the new tissue is a foreign body and attacks it. If you recognize the warning signs of tissue rejection, however, graft failure can often be prevented. To remember what to look for use the acronym RSVP: Redness Extreme Sensitivity to light Decreased Vision Pain The possibility of rejection can last for years after your surgery; that’s why steroid drops are used. If any signs of rejection are detected early, the graft is successful around 90 percent of the time. Other possible risks include eye infection, increased risk of cataracts, increased pressure within the eyeball (glaucoma), problems with stitches, and swelling of the cornea. SCHEDULE A CONSULTATION Dr. Groat is an expert corneal surgeon who employs superlative experience and all the latest technologies available to provide you with the best cornea transplant treatment available anywhere. When you need surgery, you can trust Cape Fear Cataract & Cornea to develop the best customized surgical plan for you after discussing your needs and options. Call us at (910) 769-4590 to schedule your consultation today.

  Link: Cornea Transplant

• Descemet’s Membrane Endothelial Keratoplasty

  Corneal dystrophies are inherited disorders that affect the clear outer layer of the eye. When a corneal disorder develops, abnormal material may accumulate on this part of the eye. The cornea may swell and become cloudy. In some instances, the disorder can cause discomfort in the eye and a progressive loss of vision. Cape Fear Cataract & Cornea is proud to perform advanced eye care treatments such as DMEK to help patients with corneal dystrophies regain clearer vision and a better quality of life. WHAT IS DMEK SURGERY? Descemet’s Membrane Endothelial Keratoplasty (DMEK) is an intricate eye surgery in which the innermost area of corneal tissue, including endothelial cells, is removed and replaced. WHAT EYE CONDITIONS CAN DMEK SURGERY TREAT? DMEK is a corneal procedure that is considered the standard of care for the treatment of disorders such as Fuchs’ endothelial dystrophy and Bullous Keratopathy. The technique is performed to reduce swelling and restore sharper, clearer vision. DMEK may also be considered for failed prior corneal transplants. WHAT ARE THE BENEFITS OF DMEK SURGERY? DMEK is the standard of care corneal procedure for several reasons. Minimal thickness replacement. DMEK surgery is minimally invasive and generally conservative. The procedure involves small incisions and the use of microsurgical instruments to carefully remove the centermost endothelium from the cornea. The procedure takes less time than traditional, full-thickness corneal transplant and is regarded as extremely safe and effective. Improved corneal strength. Graft dislocation is a minimal risk after DMEK surgery because only the posterior layer of tissue is replaced. Predictability. DMEK surgery does not require the placement of sutures. The procedure also does not alter the front shape or steepness of the cornea. This results in a very low chance of changes in refraction after surgery. Improved recovery. Full-thickness corneal transplant surgery has historically carried a one- to two-year journey to complete recovery. By limiting incisions and tissue modification to the central part of the cornea, surgeons substantially reduce recovery time. Most DMEK patients see clearly enough to resume driving within a month of their procedure. HOW IS DMEK EYE SURGERY PERFORMED? Descemet’s Membrane Endothelial Keratoplasty is typically performed as an outpatient procedure. Appropriate anesthesia is administered to maintain patient comfort throughout the surgical procedure. Tissue replacement involves the use of microsurgical instruments to separate a very thin layer of endothelial cells as well as the membrane situated at the backside of the cornea. The excised layer of cells is then replaced with a replica made up of healthy donor cells. The new cells are secured to the cornea with a gas bubble. Over time, the gas bubble dissipates, and the new cells integrate into the cornea. WHY CHOOSE DR. BRIAN GROAT FOR YOUR DMEK PROCEDURE? Dr. Brian J. Groat received his medical doctorate from Tulane University School of Medicine and is a board certified cataract, cornea, and glaucoma surgeon. He worked as the head of ocular trauma in 2011 at Bagram AB, Afghanistan, where he performed brain, orbital, ocular, and facial surgeries. At Cape Fear Cataract & Cornea, we are dedicated to providing our patients with the highest level of care. Dr. Groat has years of training and experience to recommend him. Dr. Groat prides himself in providing his patients with expert care and service while helping them restore and improve their vision. DMEK POST OPERATIVE INSTRUCTIONS The eye that receives donor cells requires specific care after surgery. The insertion of a gas bubble requires the patient lie on their back for the first 24 hours. After the first postoperative visit, Dr. Groat will advise the patient about positioning. Lying on your back holds the gas bubble in place and keeps the new cornea in position while the new cells start to function. WHEN CAN I RETURN TO NORMAL ACTIVITIES AFTER DMEK SURGERY? Activity restrictions will continue over the first week after surgery. After the 1 week visit, normal activities can be resumed, with the exception of very strenuous activity. Patients may be able to resume driving and performing light activities within a week after DMEK surgery. Eighty percent of the healing that needs to occur takes place within the first month after treatment. Full recovery is usually complete within four to six months. WILL DMEK TREATMENT AFFECT MY VISION? Initially, vision will be very blurry after DMEK surgery. This is because slight swelling and the presence of the gas bubble in the eye mildly distort the passage of light through the eye. As the gas bubble dissipates over seven to ten days, vision continues to improve. When there are no other eye problems, DMEK can result in 20/20 vision within a few months after treatment.

  Link: Descemet’s Membrane Endothelial Keratoplasty

• Glaucoma

  WHAT IS GLAUCOMA? Glaucoma is a blinding disease of the optic nerve and has been referred to as the “sneak thief of sight” because it may progress without any warning symptoms. Most commonly, glaucoma damage is associated with elevated intraocular pressure above the normal level. Just as a tire is filled with air to a specific pressure, the eye is a hollow organ with fluid normally maintained within a normal range of fluid pressure. The only proven way to slow the progression of glaucoma is to lower the intraocular pressure. HOW IS GLAUCOMA DIAGNOSED? Cape Fear Cataract & Cornea is a superbly equipped ophthalmology clinic where patients benefit from state of the art glaucoma evaluation instrumentation in addition to the skillful clinical evaluation of comprehensive eye exams. Specifically, our surgeon Brian J. Groat, M.D., utilizes photographic stereo (3D) evaluation of the optic nerve, automated visual field exams with the Humphrey field analyzer, and/or optic nerve fiber layer monitoring with Heidelberg Ocular Coherence Tomography. AM I A CANDIDATE FOR GLAUCOMA TREATMENT? Glaucoma is a condition that provides little, if any, clues regarding damage to the optic nerve. This is why dilated eye exams are so important. When an eye exam discovers elevated intraocular pressure, the best course of action is a good follow-up. Frequent follow-up exams enable the eye doctor to get a good sense of whether or not glaucoma is the true cause of this elevation. When the glaucoma risk is low, visits may take place every 6 to 12 months. When it is higher, they will be scheduled more frequently. Through careful observation of the optic nerve and routine measurements of intraocular pressure, an eye doctor can determine the best timing for glaucoma treatment. Eye drops are typically prescribed before surgery is considered for the treatment of glaucoma. GLAUCOMA TREATMENT A large percentage of glaucoma patients are successfully treated with pressure-lowering topical eye drops. When medication is not effective, laser or other surgeries may be employed. Increasingly, glaucoma laser treatment is being used worldwide not only when drops are ineffective, but also as a first-line treatment alternative to chronic eye drops. The need for topical drops is often reduced after the performance of such procedures. HOW MUCH DOES GLAUCOMA SURGERY COST? Several factors may influence the cost of glaucoma surgery, such as the inclusion of additional techniques like cataract removal. During our consultation, we discuss all aspects of care thoroughly, including a cost breakdown. IS GLAUCOMA SURGERY SAFE? Glaucoma Surgery is typically very successful at substantially slowing the progression of glaucoma and achieving the intended eye pressure. Furthermore, if glaucoma is inadequately treated, it is almost certain that vision will be lost. Although glaucoma surgery can prevent further vision loss and on rare occasions improves vision, the damage that has already occurred as a result of glaucoma is considered permanent and not yet reversible. IS GLAUCOMA PAINFUL? In most cases, glaucoma is not painful. This is why the condition is referred to as a “silent thief of sight.” There are various types of glaucoma, with primary open-angle glaucoma being the most common. In this disease, intraocular pressure increases gradually. The slow speed at which intraocular pressure and vision changes provide very little indication of danger. Patients rarely feel discomfort as their optic nerve is progressively damaged. In some situations, patients may encounter an acute angle-closure glaucoma attack. This rapid increase in intraocular pressure may cause pain that is intense enough to provoke nausea or vomiting. The attack also affects the cornea, causing vision to become cloudy. Acute angle-closure glaucoma attack is a medical emergency that requires prompt care. With treatment, pain is immediately soothed but may take weeks to resolve completely. Secondary forms of angle-closure glaucoma may also cause symptoms such as pain by increasing pressure within the eye. DOES INSURANCE COVER GLAUCOMA SURGERY? Being an eye disease, glaucoma is a condition for which treatment may be at least partially covered by medical insurance. Patients should contact their health insurance carrier, not their vision insurance, for more information about benefits that cover glaucoma treatments. SCHEDULE A CONSULTATION If you want to learn more about glaucoma treatment options contact Cape Fear Cataract & Cornea, P.A. at (910) 769-4590 to schedule your consultation today.

  Link: Glaucoma

• Dry Eye

  The eye is an amazing camera, and few man-made cameras even begin to compare with the incredible human eye. Like the front surface of a photographic camera, the front surface of the eye also must have an exquisitely smooth, “polished” surface for crisp and clear images. The tear film is the critical front surface of the eye for high-quality images. In addition to its optical function, the tear film serves an important nutrient role for maintaining the health of the cornea. While there are many other star players in the eye’s visual pathway (cornea, lens, retina, optic nerve, visual pathways in the brain), the tear film is an absolutely critical support player with a vital function often taken for granted… until it doesn’t function optimally. The tear film consists of three layers: an inner mucous layer which helps the tears to adhere to the surface of the eye a middle lubricating water layer secreted by the lacrimal gland an outer oil layer, secreted by oil glands on the lid margin, which stabilizes the tear film and slows evaporation WHAT IS DRY EYE? Dry eye is the term used when the tear film is inadequate. Normally, the surface of the eye is constantly covered with a uniform layer of constantly produced tears replenished by normal and automatic frequent blinking. When the tear film dries, vision immediately becomes blurry as this is equivalent to roughing the normal smooth front surface of a camera lens. SYMPTOMS OF DRY EYE Patients with dry eye or ocular surface disease complain of: tearing burning stinging redness irritation blurred vision inability to wear contacts comfortably general foreign body sensation Often patients remark, “But my eyes are not dry. They run water all the time.” In fact, excess tearing, known as epiphora, is a common symptom of dry eye. When the corneal surface dries, the eye responds with reflex tearing to try and reestablish adequate lubrication. This is demonstrated by the tearing that sometimes results in daily activities when excess wind dries the cornea (for example, when walking out into a windy day, riding in a boat, driving with the windows down or with air vents blowing straight into one’s face, etc.) Unfortunately, this reflex tearing does not sufficiently compensate for a constantly inadequate tear film. CAUSES OF DRY EYE Dry eye is more common with advancing age, but can occur at any age and in both sexes. Causes besides aging include hormonal change, auto-immune disease, medications, poor blinking and past ocular injuries among others. HOW IS DRY EYE DIAGNOSED? Dr. Groat will evaluate your tear film composition and tear production to determine the problem. You will be asked about health complications, medications, and past ocular injuries to determine if that is a cause. HOW TO RELIEVE DRY EYE Treatments for dry eye may be specifically designed depending on which layers are primarily deficient. Treatments options are non-surgical or even surgical if eyelid malpositions are a factor. NON-SURGICAL DRY EYE TREATMENT Therapy usually begins with over-the-counter artificial tears, but may also include oral supplements (fish oil, omega-3s), prescription drops to increase tear production (Restasis), punctal plugs to slow drainage of the natural tears produced, antibiotics and/or hygiene regimens to treat lid margin/oil (Meibomian) gland dysfunction. SURGICAL DRY EYE TREATMENT If less invasive methods are unsuccessful, surgical treatments, which include the following, may be an option: Insertion of punctal plugs to limit tear drainage Punctal cautery to permanently close the drainage holes Treatment of an underlying disease If an eyelid condition is causing dry eye, eyelid surgery may be recommended. WHAT HAPPENS IF DRY EYE IS LEFT UNTREATED? If dry eye is left untreated, it can lead to complications that include pain, corneal ulcers/scars. There also is the potential to damage vision. HOW TO PREVENT DRY EYE There are steps that can be taken to prevent dry-eye symptoms. Simple lifestyle modifications such as wearing protective glasses on windy days, and giving the eyes a break during reading or other tasks that require intense focus, can effectively reduce the frequency and severity of symptoms SCHEDULE A CONSULTATION Cape Fear Cataract & Cornea uses a step-wise approach to treat ocular surface disease. Call today at (910) 769-4590 to schedule an appointment.

  Link: Dry Eye