Eyecare Services

Does the change of seasons cause your eyes to be itchy, watery, or swollen?  Allergic conjunctivitis is the term used to describe allergies specifically affecting your eyes.  At Frontier Eye Care, we can help you find relief from your allergic conjunctivitis.

So what causes allergic conjunctivitis?  When an allergic reaction takes place, your eyes may be overreacting to a substance perceived as harmful, even though it may not be.  These substances are called allergens.  Common allergens in Casper and Central Wyoming include pollens from our native plant species, cottonwood, and dust.  Adverse reactions to pet dander, certain cosmetics, and drugs can also cause eye allergies.

These allergens may be harmless to most people, but can cause excessive production of tears and itching in eyes of overly sensitive, allergic individuals.  With allergies, your body’s release of histamine from “mast cells” causes your eyes to water and itch, just as it may cause your nose to run.

The most common “treatment” is to avoid what’s causing your eye allergy in the first place.  Keep your home free of pet dander and dust and keep pets off the furniture.  Stay inside with the air conditioner on when a lot of pollen or the cottony seeds from cottonwood trees are in the air.  Use high quality HEPA furnace filters that trap common allergens and replace your filters frequently.

Make sure you wear wraparound sunglasses to help shield your eyes from allergens, and drive with your windows closed during allergy season.

If you’re not sure what’s causing your eye allergies, or you’re not having any luck avoiding them, your next step probably will be medication to alleviate the symptoms.

Topical (eye drop) antihistamines are usually very effective, and are usually much better than some over-the-counter products, such as Visine, which can have side effects.  Some antihistamines also act as mast cell stabilizers, which prevent histamines from being released in the first place.  The antihistamines provide immediate relief, while the mast cell stabilizers are known for their long-lasting relief.

For more severe cases, we may prescribe anti-inflammatory eye drops to decrease swelling, inflammation, and other symptoms associated with seasonal allergic conjunctivitis.

If you’re bothered by allergic conjunctivitis, schedule an appointment with Dr. Alden.  She’ll be glad to discuss your options, and find a treatment that is most effective for you.

Call Frontier Eye Care to schedule your next appointment at (307) 472-2020.

Another Cause of Watery Eyes

Of course, allergies can cause excessively watery eyes.  But another common condition can lead to tearing as well – Dysfuntional Tear Syndrome or “dry eye syndrome.”

It may seem illogical that dry eye syndrome could cause watery eyes.  But sometimes an underlying dry eye condition stimulates your tear glands to overproduce the watery component of your eye’s tears as a protective response, leading to watery eyes.

By examining your eyes, we can determine what’s causing the watering, and find relief!

At Frontier Eye Care, we’re experts in allergic conjunctivitis as well as dry eye management.  We can determine what’s causing your watery eyes and take care of your problem either way.  Talk to us today at (307) 472-2020 if watery itchy eyes are bothering you.

At the time of birth, all children have very poor vision.  But as an infant grows and develops, they learn how to see (just as they learn to control their arms and hands, or learn to walk and talk).

Amblyopia, also known as “lazy eye”, is a visual condition in which an eye fails to learn to see as well as it should, even with prescription eyeglasses or contact lenses.  Because amblyopia is a condition that begins during infancy and early childhood, it often goes undetected until the child is older.

In some cases of amblyopia, reduced visual acuity can occur in both eyes.  But usually, only one eye is affected.  If lazy eye is detected early in life and promptly treated, reduced vision can be avoided.  But if left untreated, lazy eye can cause severe visual disability in the affected eye, including legal blindness.

What Causes Amblyopia?

One common cause of amblyopia is strabismus (eye turn).  To avoid double vision caused by poorly aligned eyes, the brain ignores the visual input from the misaligned eye, and doesn’t learn to see properly with that eye (the “lazy eye”).  This type of amblyopia is called strabismic amblyopia.  If you notice that your baby or child has “crossed eyes,” or one eye seems to “wander” out, schedule an appointment with Frontier Eye Care immediately.

Another cause of amblyopia is a large difference is refractive error (nearsightedness, farsightedness, or astigmatism) in one eye compared to the other, despite perfect eye alignment.  If your young child cries or becomes irritated when you cover one eye, this may suggest that the eye you have covered is the “good” eye, and that the uncovered eye is amblyopic, causing blurred vision.  In such cases, the brain “tunes out” the blurry vision from the worse eye, causing amblyopia in that eye from disuse.  This type of amblyopia is called refractive amblyopia (or anisometropic amblyopia).

The best time to detect and treat amblyopia is when a child is very young.  Frontier Eye Care offers free screenings for infants between 6 and 12 months old.  We’ll be glad to check your child’s eye alignment and refractive status to make sure then don’t have any “amblyogenic factors” that can lead to amblyopia.  But amblyopia can also be treated when a child is older, so it’s never too late to have them checked.

Treatment of Amblyopia

In some cases, normal vision can be achieved simply by fully correcting the refractive errors in both eyes with glasses or contact lenses.  Usually, however, at least some patching of the “good” eye is needed to encourage the brain to pay attention to the amblyopic eye and enable vision development to occur in that eye.

Patching may be required for several hours each day and may continue for weeks or months.  If your child refuses to wear the patch, we have other treatment options such as eye drops or special contact lenses.

Treatment of strabismic amblyopia sometimes involves surgery to straighten the eyes, followed by eye patching and often some form of vision therapy to help both eyes work together equally as a team.  Although Frontier Eye Care does not perform eye surgery or vision therapy, we will refer your child to the best qualified teams of eye surgeons and specialists.

Amblyopia will not go away on its own, and untreated lazy eye can lead to permanent vision problems and poor depth perception.  If your child’s “good eye” ever develops disease or is injured, he or she will have to depend on the poor vision of the amblyopic eye, so it is best to treat amblyopia early on.

If you suspect your child may have amblyopia, or if your child has never had an eye exam, please call Frontier Eye Care to schedule an appointment at (307) 472-2020.  We love working with kids, and strive to make our pediatric exams fun and enjoyable for them.

Blepharitis is a very common eyelid condition that results in burning, itching, redness, tearing, and irritation of the lids and eyes.  Blepharitis is also a cause of uncomfortable dry eyes and a foreign body sensation.  It is associated with an excess of bacteria that accumulate at the base of the eyelashes and cause these symptoms.  People with certain skin conditions such as acne rosacea tend to be more likely to develop blepharitis.

Blepharitis has two basic forms:  Anterior Blepharitis and Posterior Blepharitis.  It’s not uncommon to have both anterior and posterior forms of blepharitis at the same time, but in different degrees of severity.  Anterior blepharitis affects the outside front of the eyelid where eyelashes are attached.  Bacteria cause the lids to become red, itchy, and irritated.

In the case of posterior blepharitis, bacteria lead to dysfunction of meibomian glands within the lids.  Meibomian glands normally secrete oils that help lubricate your eyes, so posterior blepharitis can cause very dry eyes.

Treatment for Blepharitis

If Dr. Alden diagnoses you with chronic blepharitis, she will likely recommend an ongoing regimen of eyelid hygiene that can include commercially developed, over-the-counter lid scrubs or other cleansing agents.

Research has shown that in many cases of posterior blepharitis, omega-3 fatty acid supplements can help your meibomian glands function better and provide essential lubrication for eye comfort.  Warm compresses and lid massage can also be helpful to encourage normal secretion from your meibomian glands.

Besides a program of eyelid hygiene, if you have severe blepharitis and related symptoms, you may require treatment with topical and oral antibiotics.

Is There a Cure for Blepharitis?

A complete blepharitis cure may not exist.  But as explained above, good eyelid hygiene and prescription medicine are often effective in managing blepharitis, while warm compresses and lid massages can help unclog obstructed meibomian glands.

Be sure to ask Dr. Alden about blepharitis if your eyelids are red, itchy or irritated.  We’ll create a custom treatment plan to give you long-lasting relief.  Call Frontier Eye Care at (307) 472-2020 to make an appointment.

A cataract is a clouding of the eye’s natural lens, which lies behind the iris and the pupil.  (The purpose of the lens is adjusts the eye’s focus, letting us see things clearly both up close and far away.)  But the lens changes as we age, losing its flexibility, and eventually becomes cloudy.

Cataracts are caused by chemical changes that occur within the lens.  Although some people are born with cataracts, they are more common with age.  In fact, cataracts are the most common cause of vision loss in people over age 40 and are the principal cause of blindness in the world.

Some say, “If you live long enough, you’ll get cataracts.”  Besides increasing age, other risk factors for cataracts include diabetes, excessive alcohol consumption, excessive exposure to sunlight, family history of cataracts, high blood pressure, obesity, and smoking.  Cataracts can also be caused by eye injury, previous eye surgery, and long-term use of certain medications such as corticosteroids like prednisone.

Cataract Symptoms and Signs

Usually, a cataract starts out small and at first has little effect on your vision.  You may notice that your vision is blurred a little, like looking through a smoked glass.

A cataract may scatter light from the sun, indoor lighting, or headlights at night, making the light seem too bright or glaring.  Colors may appear duller, and not as bright as they once did.  Cataracts can also cause a shift in your eyeglass prescription.

Exposure to ultraviolet light seems to be associated with cataract development, so we recommend wearing sunglasses and a wide-brimmed hat to reduce your exposure.

Also, several studies have suggested that eating a healthy diet rich in antioxidants and certain vitamins can reduced your risk of cataracts, and may slow their progression.

Cataract Treatment

When symptoms begin to appear, we may be able to improve your vision for a while using new glasses, strong bifocals, magnification, appropriate lighting or other visual aids.

We’ll discuss cataract surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life.  Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

How Cataract Surgery Works

Cataract surgery is very successful in restoring vision.  In fact, it is the most frequently performed surgery in theUnited States, and has the highest patient satisfaction rating of any medical procedure.

During surgery, the surgeon will remove your clouded lens and in most cases replace it with a clear, plastic intraocular lens (IOL).

Cataract surgery is not without potential complications, however, such as infection.  But complications are rare, especially in the hands of an experienced cataract surgeon.  Also, men should be aware that certain prostate drugs can cause a specific type of complication during a cataract procedure, and should alert their cataract surgeon if they are taking medications for prostate.

If cataracts are blurring your vision, we can evaluate and advise you about various procedures and refer you to a surgical cataract specialist.  Cataract surgery usually changes your eyeglass prescription, so we’ll see you about six weeks after your surgery for a refraction to recheck your eyewear needs.

If you think you may have a cataract, please call our office at (307) 472-2020 to schedule an appointment with Dr. Alden to find out for sure.

Diabetic retinopathy (DR) is the leading cause of blindness from disease or injury among Americans younger than age 65.  Yet, many cases could be prevented with regular eye exams and appropriate treatment.

Generally, diabetics don’t develop diabetic retinopathy until they have had diabetes for several years. But it is unwise to wait that long for an eye exam.  If you have been diagnosed with diabetes, visit Frontier Eye Care dilated eye exam at least once a year.

How Does Diabetes Cause Diabetic Retinopathy?

Uncontrolled diabetes allows unusually high levels of blood sugar (hyperglycemia) to accumulate in blood vessels.  Eye damage occurs when the high blood sugar damages blood vessels within the eye’s retina, which contains light-sensitive cells (photoreceptors) necessary for good vision.

Symptoms of Diabetic Retinopathy

Early diabetic retinopathy usually has no symptoms.  During more advanced stages of diabetic retinopathy (or other eye problems related to diabetes), you may notice symptoms such as:

• Sudden appearance of eye floaters,
• Development of a shadow in your vision
• Blurry or distorted vision
• Shift in eyeglass prescription
• Double vision
• Eye pain
• Cataracts

During your eye examination, Dr. Alden will look for other signs of diabetic retinopathy and diabetic eye disease.  Signs of eye damage found in the retina can include swelling, deposits, and evidence of bleeding or leakage of fluids from blood vessels.

For a definitive diagnosis of bleeding or leakage in your retina, we may perform a painless diagnostic test called optical coherence tomography (OCT).  This test allows us to image the layers of your retina.  If swelling or fluid is detected, we will refer you to a retinal specialist for treatment to stop the blood vessels from leaking.

Preventing Diabetic Retinopathy

If you want to avoid diabetic retinopathy or control its progress, try these tips:

• Keep blood sugar within normal limits.
• Monitor blood pressure and keep it under good control.
• Maintain a healthy diet.
• Exercise regularly.
• Don’t smoke.
• Follow your doctor’s instructions to the letter.
• Above all, make sure you have regular eye exams!

How tightly you control your blood sugar is a major factor determining how likely you are to develop diabetic retinopathy.  A test from your physician, called hemoglobin A1c, can measure how well you have been controlling your blood sugar over the prior three months.  Be sure to ask your family physician what your A1c levels are.

Uncontrolled high blood pressure (hypertension) has also been associated with eye damage related to diabetes.  So be sure to have your blood pressure checked as well.

Of course, the longer you have diabetes the more likely you are to have vision loss.  Diabetes, if uncontrolled, can cause irreversible blindness.  To lower your risk of diabetic retinal diseases, follow the guidelines listed above and have your eye checked regularly.

If you are diabetic (or have a family history of diabetes) schedule your comprehensive dilated eye exam every year with Frontier Eye Care in Casper at (307) 472-2020.

Tears are essential for healthy eyes.  They bathe the eye, wash out dust and debris, and keep the eye feeling moist.  Tears also contain enzymes that neutralize harmful microorganisms.

Dry eye syndrome (or “dysfunctional tear syndrome”) is a chronic lack of tears (or sometimes poor quality tears) on the surface of the eye.  It can lead to problems ranging from subtle burning and irritation to severe inflammation of the cornea and conjunctiva.  The medical term for dry eye, keratoconjunctivitis sicca, refers to eye dryness affecting the cornea and conjunctiva.

Dry Eye Symptoms

Persistent dryness, scratchiness and a burning sensation in your eyes are symptoms of dry eyes. Another symptom of dry eyes is a “foreign body sensation,” the feeling that something is in the eye.

Ironically, dry eye syndrome can often cause your eyes to be watery.  Lack of good quality lubricating tears can overstimulate production of the watery component of your tears as a protective mechanism.  The poor quality (watery) tears can flush out the good quality tears, only making matters worse.

What Causes Dry Eyes?

In dry eye syndrome, the lacrimal gland or associated glands near the eye either don’t produce enough good-quality tears, or the tears are poor-quality which causes them to evaporate too quickly.

Dry eye syndrome often occurs as a part of the natural aging process, especially during menopause.  Certain medications can also dry your eyes, especially antihistamines, antidepressants, certain blood pressure medicines, and birth control pills.  A dry, dusty or windy climate (such that we have inWyoming), smoking, and contact lenses will also make dry eyes worse.

Central air conditioning and forced-air furnaces dry out the air in your home or office, causing dry eyes. Reading or using a computer can be a problem, since we tend to blink less frequently when we are concentrating.

Dry eyes can also be a symptom of other diseases such as lupus, rheumatoid arthritis, rosacea, or Sjogren’s syndrome.  And dry eye syndrome is more common among women, likely due to hormone fluctuations.

If you are considering LASIK, be aware that dry eyes may disqualify you for the surgery, at least until the problem is resolved.

Treatment for Dry Eyes

Dry eye syndrome is usually a chronic condition that may not be completely curable (depending on the cause).  But the symptoms of burning and scratchiness can be managed.  Dr. Alden will recommend lubricating artificial tear drops that may alleviate the dry, scratchy feeling.

Omega-3 fatty acid supplements have also been shown to improve the quality of tears.  You can try one or two capsules twice a day.  If you notice an improvement in your dry eye symptoms after two weeks, simply continue taking the capsules.

Make sure you are well hydrated by drinking plenty of water or juice.  Try to quit smoking, and avoid smoky places.  If possible, use a humidifier or vaporizer in your home and office.  An air purifier or air cleaner can filter dust and other particles.  When outdoors, wear sunglasses to reduce exposure to sun, cold, wind, and dust.  We can recommend a close-fitting wrap-around frame to effectively block wind.

Treating underlying eyelid disease such as blepharitis, can also help.  This may call for antibiotic ointment plus frequent eyelid scrubs with an antibacterial shampoo.

If contact lens discomfort is the cause of your dry eyes, Dr. Alden may switch you to a different lens or have you wear your lenses for fewer hours each day.

The tips listed above are usually effective for most people.  But if you have moderate to severe dry eye, more advanced treatment options may be necessary.  Prescription eye drops such as Restasis can help your eyes produce more tears by reducing inflammation.  And silicone punctal plugs can be inserted in the tear drainage ducts in your eyelids to keep moisture on the eye from draining too quickly.  They can be inserted painlessly while you’re in our doctor’s office and normally are not felt once inserted.

Ask Dr. Alden about these options during your eye exam to see if they are right for you.

If you are experiencing dry eye symptoms, call our office at (307) 472-2020 to schedule a tear film evaluation.  A thorough evaluation of your cornea and tear film by Dr. Alden will be helpful in determining what is causing your dry eye, and can help us tailor a treatment plan for your specific type of dry eye.

What about Visine or Clear Eyes?

Some over-the-counter eye drops are advertised to “get the red out.”  While these drops can reduce or eliminate eye redness temporarily, they may or may not be effective at lubricating the eye, depending on the formulation.

Not only that, but the chemicals in those drops that constrict the blood vessels (the vasoconstrictors) also act as a desiccant in the eyes, making them feel even more dry.  Worse yet, the vasoconstrictors are addictive.  With frequent use, the effect diminishes.  And over time, more and more is needed to achieve the same effect.  Your eyes can end up being more red in the long run!

AllAboutVision.com can educate you about treatment for dry eyes and eye strain, and the importance of eye exams.

Glaucoma refers to a group of eye disorders leading to damage of the eye’s nerve fibers.  (Millions of these nerve fibers transmit visual information from the retina to the brain.)  Damage to the nerve fibers is often associated with an increase in internal eye pressure.  But damage can also occur even if your eye pressure is normal (for example, if you are genetically predisposed and have weak nerve fibers, or have a vascular problem such as diabetes).

Early glaucoma can cause decreased visual sensitivity at the edges of your vision (peripheral vision). Unfortunately, many people with glaucoma don’t notice this decreased sensitivity in their vision.  In fact, it is estimated that 2 million Americans have glaucoma but don’t even realize it.  Untreated or uncontrolled glaucoma eventually leads to progressive vision loss and can then lead to complete blindness.

In fact, glaucoma is the second leading cause of blindness (cataracts being the first).  Unlike cataracts, however, vision loss from glaucoma is irreversible.  That’s why it is so important to detect glaucoma early.  At Frontier Eye Care, we use the latest technology such as OCT (optical coherence tomography) to detect early damage to the nerve fibers before usable vision is lost.

Symptoms of Glaucoma

Glaucoma often is called the “silent thief of sight,” because most types of glaucoma don’t cause any pain, and vision loss is usually not noticeable at first.

One type of glaucoma – acute angle-closure glaucoma – does lead to sudden, intense eye pain, as well as blurry vision, halos around lights, nausea and vomiting.  If you have these symptoms, come see us at Frontier Eye Care or visit the emergency room immediately so steps can be taken to prevent permanent vision loss.

Diagnosis, Screening and Tests for Glaucoma

During every comprehensive eye examination at Frontier Eye Care, we measure your intraocular pressure, or IOP.  Most people are familiar with the “air puff” test, which is a traditional way to measure eye pressure.  Sometimes, eye pressure is measured with an applanation tonometer, which uses a small probe to push against the front of your eye after it is numbed with eye drops.  However, for most patients, we use new technology at Frontier Eye Care which allows us to measure your pressure without the air puff or drops!  This new test is quicker and much more comfortable.

An abnormally high pressure reading indicates a problem with the amount of fluid in the eye.  Either the eye is producing too much fluid, or it’s not draining properly.  But high eye pressure is just one risk factor for glaucoma.  You can develop glaucoma even if your pressure readings are normal.  We also routinely screen every patient for early visual field loss, and carefully examine the appearance of your optic nerve fibers.

If we determine that you are at risk for glaucoma (if you have high eye pressure, a family history, or suspicious nerve fibers, for example), we will first discuss and explain our findings with you.  We can then use additional methods to determine whether treatment is necessary and monitor your glaucoma.

Sophisticated imaging technology – such as digital retinal imaging and optical coherence tomography (OCT) – allow us to create baseline images and measurements of the eye’s nerve fibers and internal structures.  Then, at specified intervals, additional images and measurements are taken to make sure no changes have occurred over time that might indicate progressive glaucoma damage.

Gonioscopy also may be performed to make sure the fluid in your eye (aqueous humor) can drain properly from your eye.  In gonioscopy, special lenses are used with a biomicroscope to enable Dr. Alden to see the structure inside the eye that controls the outflow of aqueous.

Glaucoma Treatments

Although eye pressure is only one risk factor in glaucoma, it is something we can control.  Treatment aimed at lowering eye pressure can involve medicated eye drops, laser treatment, or glaucoma surgery depending on the severity.  Usually, eye drops are tried first.

Unfortunately, many patients may become careless about using their eye drops.  In fact, non-compliance with eye drops for glaucoma is the primary reason for blindness caused by glaucoma.  If you find that the eye drops you are using for glaucoma are uncomfortable or inconvenient, consult with Dr. Alden about a possible alternative therapy.

There is no cure for glaucoma, but if detected early and treated accordingly, patients will have the opportunity to outlive their condition and limit the amount of vision that may be lost due to glaucoma.

If you would like to discuss glaucoma with Dr. Alden, simply ask during your appointment  To schedule an examination, call our Casper office at (307) 472-2020.

Eye infections and inflammation are fairly common, and can occur in any age group, and for a variety of reasons.  The term “conjunctivitis” (also known as “pink eye”) refers to inflammation of the conjunctiva, which is the clear membrane that covers the white of the eye.  There are three broad groups of conjunctivitis:

• Viral Conjunctivitis
• Bacterial Conjunctivitis
• Allergic Conjunctivitis

Only an eye doctor can correctly determine what type of conjunctivitis you may have, and properly treat it.  Each condition requires separate and distinct eye drops.

Sometimes the wrong medicine can make the condition worse.  For example, anti-inflammatory drops can allow a viral corneal infection to leave permanent scarring and decreased vision.  So please, do not try to diagnose a red eye by yourself.

If you think you have an eye infection or inflammation, schedule an appointment today so Dr.
Alden can give you the right medicine for the right condition.  Call our Casper office at (307) 472-2020.

The cornea is the clear dome in front of the colored part of your eye.  The cornea is normally round and acts like a lens to focus light into your eye.

Keratoconus is a progressive eye disease in which the normally round cornea thins and becomes misshapen, bulging into a cone-like shape.  This cone shape distorts light as it enters the eye, causing blurred vision.  However, unlike nearsightedness, farsightedness, or regular astigmatism, it is difficult to correct keratoconus with eyeglasses or soft contact lenses.

Keratoconus can occur in one or both eyes and often begins during a person’s teens or early 20s.  It is more common among men, but can affect women as well.

Keratoconus Symptoms and Signs

As the cornea becomes more irregular in shape, it causes progressive nearsightedness and irregular astigmatism to develop, creating additional problems with distorted and blurred vision.  Glare and light sensitivity also may occur.

What Causes Keratoconus?

New research suggests that an imbalance of enzymes within the cornea cause weakening of the corneal tissue which leads to keratoconus.  This imbalance makes the cornea more susceptible to oxidative damage from free radicals, causing it to weaken and bulge into the cone shape.

Risk factors for oxidative damage and weakening of the cornea include a genetic predisposition, explaining why keratoconus often affects more than one member of the same family.

Keratoconus is also associated with overexposure to ultraviolet rays from the sun, excessive eye rubbing, a history of poorly fitted contact lenses and chronic eye irritation.

Keratoconus Treatment

During the early or mild stages of keratoconus, eyeglasses or soft contact lenses may help.  But as the disease progresses and the cornea thins and becomes increasingly more irregular in shape, glasses and soft contacts no longer provide adequate vision correction.

Treatments for moderate and advanced keratoconus include:

Gas permeable contact lenses

If eyeglasses or soft contact lenses cannot control keratoconus, then rigid gas permeable (RGP or GP) contact lenses are usually the preferred treatment. Their rigid lens material enables GP lenses to vault over the cornea, replacing its irregular shape with a smooth, uniform refracting surface to improve vision.  But RGP contact lenses can be less comfortable to wear than soft contacts, the fitting RGP contacts for keratoconus can be time-consuming and require several visits.

Hybrid contact lenses

Hybrid contact lenses combine a rigid center with a soft peripheral border or “skirt.”  They were designed specifically for keratoconus and vault above the eye’s cone shape for increased comfort.  The manufacturer says hybrid contacts provide the crisp optics of a GP lens and wearing comfort similar to that of soft contact lenses.

INTACS

A newer procedure to help flatten a keratoconic cornea call INTACS was pioneered in France, and is routinely being done by corneal specialists in the US.  This procedure may be a good option for patients who are contact lens intolerant and who want to avoid a corneal transplant.  INTACS involves the insertion of two arc-like plastic segments into the middle of the cornea to flatten it.  A high-precision femtosecond laser is used to make the channels to insert the plastic segments.

Corneal Cross-Linking

Corneal cross-linking (CXL) is a non-invasive procedure used to strengthen corneal tissue which can slow or halt bulging of the cornea in keratoconus.  With CXL, riboflavin (a type of B vitamin) is applied to the cornea, and then activated with UV light.  Early results showing benefits of this method have been promising. Researchers have found that this simple treatment might significantly reduce the need for corneal transplants among keratoconus patients.

Corneal Transplant

Some people with keratoconus reach the point where contact lenses or other therapies no longer provide acceptable vision.  The cornea buldges so much that it becomes cloudy, a condition called hydrops.  The last remedy to be considered may be a cornea transplant, also called a penetrating keratoplasty (PK).  Even after a transplant, however, the patient still needs glasses or contact lenses for clear vision.

At Frontier Eye Care, we use the most advanced corneal topography technology to diagnose keratoconus.  If we find that you have keratoconus, we will explain your condition and discuss the best treatment options with you.  Call (307) 472-2020 to schedule an appointment.

For more information about keratoconus, visit The Keratoconus Center at www.keratoconus.com.

The macula is the central portion of your retina responsible for the sharp, central vision needed for reading or driving.  It is where retinal photoreceptors are most densely packed, and is the most metabolically-active portion of the eye.

Age-related macular degeneration (ARMD or AMD), is a gradual deterioration of the macula.  Macular degeneration mainly affects central vision, causing decreased vision directly ahead.  It is the leading cause of decreased vision among Americans age 65 and older.  In fact, 25% of all Americans over the age of 75 have macular degeneration.

Wet and Dry Forms of Macular Degeneration

The early stage of macular degeneration is referred to as the “dry” (non-neovascular) form.  About 85 percent of AMD patients are diagnosed with dry AMD.  The “wet” (neovascular) form of macular degeneration usually leads to more serious vision loss.

Dry AMD results from the gradual aging and thinning of macular cells.  Yellowish spots known as drusen begin to accumulate in and around the macula.  It is believed these spots are deposits of waste-products from deteriorating cells.  The drusen may block nutrients and oxygen from reaching the photoreceptors of the macula, leading to further deterioration.

Gradual central vision loss may occur with dry macular degeneration but usually is not nearly as severe as wet AMD symptoms.  However, even dry AMD can slowly progress to late-stage geographic atrophy (gradual degradation of retinal cells that also leads to significant vision loss) over a period of years.

In about 10 percent of cases, dry AMD progresses to the more advanced and damaging wet (neovascular or exudative) form of the eye disease.  New blood vessels grow beneath the retina, trying to get more nutrients and oxygen to the macula.  Unfortunately, these new vessels tend to leak blood and fluid, causing more harm than good.  This leakage causes permanent damage to light-sensitive retinal cells, which die off leaving blind spots in central vision.

Macular Degeneration Symptoms and Signs

Age-related macular degeneration usually produces a slow, painless decrease in vision, although in some cases vision loss may be sudden.  Early signs of AMD include darker areas in your central vision or blurry or distorted vision.

At Frontier Eye Care, we utilize technology that can detect early signs of macular degeneration before symptoms occur.  If we detect early signs of AMD (such as drusen deposits) during your retinal eye exam, we will then scan your maculas with “optical coherence tomography” (OCT).  The OCT scan takes just a couple of minutes.  OCT is an optical scan, and is completely painless.  But it can give us information similar to an ultrasound or MRI to see beneath your maculas and rule out early signs of wet macular degeneration.

PHOTO OF OCT.  CAPTION:  If Dr. Alden detects early signs of ARM, such as a defect in your central vision, she may perform a scan of your macula called optical coherence tomography (OCT).  This test can help rule out swelling or bleeding of the macula if your AMD has progressed to the wet form.

What Causes Macular Degeneration?

Though macular degeneration is associated with aging, research suggests there also is a genetic component to the disease, and it seems to run in families.  Deteriorating, oxygen-starved cells within the retina likely trigger neovascularization (abnormal blood vessel growth) which can lead to damage in wet AMD.  Neovascularization is activated by a protein called vascular endothelial growth factor (VEGF).

Who Gets Age-Related Macular Degeneration?

Besides affecting older populations, AMD occurs more frequently among Caucasians and females in particular.  The disease also can result as a side effect of some drugs, such as hydroxychloroquine.

Irrefutable evidence indicates that smoking cigarettes is the greatest controllable risk factor for macular degeneration.  In fact, just living with a smoker will double your risk for AMD.  Other risk factors for macular degeneration include having a family member with AMD, high blood pressure, and obesity.  High levels of dietary fat, especially saturated fats and trans fats, may also contribute to the development of AMD.

Treatment of Macular Degeneration

There is no outright cure for age-related macular degeneration, but some treatments may delay its progression or even improve vision.  Treatments for macular degeneration depend on whether the disease is in the early, dry form or in the more advanced, wet form.

No FDA-approved treatments exist for dry macular degeneration.  However, major studies by the National Eye Institute called the “Age-Related Eye Disease Studies” (AREDS and AREDS 2) have shown that certain anti-oxidant vitamins may help slow progression of dry macular degeneration, and make it less likely to progress to the wet form.  Ask us which AREDS multivitamins are right for you.

If we determine you have wet AMD, we will refer you to a retinal specialist for treatment.  Most likely, you will be treated with one of the newer anti-VEGF drugs.  These drugs block the vascular endothelial growth factor (VEGF) that triggers the abnormal blood vessel growth.  Sometimes, these drugs not only stop the progression of AMD, but can actually improve your vision.

At Frontier Eye Care, your eye health and the future of your vision is our greatest concern.  An annual comprehensive eye exam will help ensure that we detect early signs of macular degeneration, and preserve your vision to the greatest extent possible.

Call Frontier Eye Care at (307) 472-2020 if you have questions about macular degeneration or to schedule your next eye exam, especially if you are concerned about macular degeneration or have a family history.

The retina is the inside lining of the back of your eye.  It contains millions of photoreceptors (rod and cone cells) that detect light from the image you are looking at, and send a signal to your brain.  The retina is like the film in a camera.

A detached retina occurs when the retina becomes separated from its underlying supportive tissues.  The retina cannot function when these layers are detached.  A retinal detachment is a serious and sight-threatening event, and permanent vision loss may result unless the retina is reattached soon.

Symptoms of a Detached Retina

If you suddenly notice many spots (floaters) in your vision and/or flashes of light, you may be experiencing the warning signs of a small retinal tear or detached retina.  Your vision might also become blurry.  If you see a dark region like a shadow or curtain at the top, bottom, or sides of your vision, it is very possibly a retinal detachment.

These signs can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches quickly.

Flashes of light and floaters can also be the sign of less serious conditions, such as a vitreous detachment.  However, one in seven people who experience a sudden onset of flashes and floaters will have a retinal tear or detachment.  Up to 50 percent of people who experience a retinal tear will have a subsequent detachment.

No pain is associated with retinal detachment.  If you experience any of the signs, stop by Frontier Eye Care or another eye doctor right away.  Immediate treatment increases your odds of regaining lost vision.

What Causes Retinal Detachments?

An injury to the eye or head can cause a detached retina, as the force of trauma can cause the retinal to loosen or tear.  Cataract surgery, tumors, eye disease and systemic diseases such as diabetes and sickle cell disease also may cause retinal detachments.  Over time, the vitreous (jelly-like filling of the eye) tends to shrink.  The vitreous eventually pulls away from the retina.  This is called a vitreous detachment.  If the vitreous tears the retina, instead of pulling away gently, this can cause a hole in the retina, which can lead to a retinal detachment.

Certain diseases such as diabetic retinopathy or wet macular degeneration can cause abnormal leaky blood vessels to grow under the retina.  The leakage may push the retina forward and lead to a “serous” or fluid retinal detachment.

Interestingly, very nearsighted people have longer eyeballs with thinner retinas that are more prone to detaching.

Treatment for Detached Retina

Surgery is required to repair a detached retina. The procedure usually is performed by a retinal specialist — an eye surgeon who has undergone advanced training in the medical and surgical treatment of retinal disorders.

Surgical procedures used to treat a retinal detachment include:

Scleral buckling surgery. This is the most common retinal detachment surgery, and consists of attaching a small band of silicone or soft plastic to the outside back of the eye.  This band compresses (buckles) the eye inward, reducing the pulling traction of the retina and allows the retina to reattach to the inner wall of the eye.  This also makes additional detachments less likely.

Vitrectomy. In this procedure, the clear jelly-like fluid is removed from the posterior chamber of the eye (vitreous body) and replaced with clear silicone oil to push the detached portion of the retina back.

Pneumatic retinopexy. In this procedure, the surgeon injects a small bubble of gas into the vitreous body to push the detached portion of the retina onto the supporting tissues.

If the detachment is caused by a tear in the retina, the surgeon usually uses a laser or a freezing probe to “spot weld” the retina firmly onto the underlying tissues and thereby prevent the tear from leading to a retinal detachment.  If a laser is used, this is called laser photocoagulation.  The freezing probe is called cryopexy.

Surgical reattachment of the retina isn’t always successful.  The odds for success depend on the location, cause, and extent of the retinal detachment, along with other factors.  Also, successful reattachment of the retina doesn’t guarantee normal vision. Generally, visual outcomes are better after surgery if the detachment is limited to the peripheral retina and the macula is not affected.

Time is of the essence during a retinal detachment.  If you experience a sudden onset of multiple floaters in your vision, flashes in your vision, and/or a dark region in your vision, do not wait or ignore these signs.  Stop by Frontier Eye Care in Casper right away.  If it is after hours, visit the Wyoming Medical Center emergency room, and the ophthalmologist on-call will examine your eyes.