Procedures

Cataract Surgery Techniques

Using the extracapsular cataract extraction technique, the surgeon makes an incision where the cornea and sclera meet. Carefully entering the eye through the incision, the surgeon gently opens the front of the capsule and removes the hard center, or nucleus, of the lens. Using a microscopic instrument, the surgeon then suctions out the soft lens cortex, leaving the capsule in place.

Phacoemulsification is a modification of the extracapsular cataract extraction. In phacoemulsification, the nucleus is fragmented by an ultrasonic oscillating probe. The nuclear fragments are simultaneously suctioned from the eye. The size of the incision is smaller that the incision needed to remove the capsule in the extracapsular technique.

An intraocular lens (IOL) is a clear plastic lens that is implanted in the eye during the cataract operation. Lens implants have certain advantages. They usually eliminate or minimize the problems with image size, side vision and depth perception noted by people who wear cataract eyeglasses. They are also more convenient than contact lenses because they remain in the eye and do not have to be removed, cleaned, and reinserted.

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Glaucoma Procedures

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Examination
-Visual examination by the doctor of all inner structures of the eye including the retina, optic nerve head and optic disc. Any damage due to glaucoma is identified and noted in your medical record.

Visual Field
-Test of the eye's ability to correctly respond to light on all parts of the retina. Areas damaged by glaucoma will show no response. Periodic visual fields are essential for showing the condition of your eye now and for immediately detecting future changes due to glaucoma. Visual fields are carried out with a machine called a perimeter.

Fundus Photo
-Photograph of the entire inner surface of your eyeball (fundus). A picture of the inner surface permits an accurate record of its condition which can be reviewed later when looking for evidence of change.

Gonioscopy
-Use of a special lens to examine mesh-like drains in your eye to see if they are blocked or unblocked. The aqueous fluid in the eye flows through these drains. Blocked drains cause eye pressure to build. Information about these drains is required to correctly diagnose the kind of glaucoma present and determine the appropriate treatment.

Tonometry
-Measurement of the pressure inside your eye (called intraocular pressure or "IOP"). Too high a pressured causes damage to the optic nerve and a loss of sight. Maintaining pressure at the normal level is a primary goal of treatment.

Treatment Options

Medication
-Both eye drops and oral medication may be used to lower your intraocular pressure ("IOP"). Drops usually need to be taken several times a day while oral medication usually needs to be taken two or three times each day. You must take the medication as prescribed to halt the progress of your disease.

Conventional Surgery
-Surgical procedures create an alternate passageway which allows the fluid in your eye to more easily drain out. This lowers the "IOP" and thus prevents a further loss of vision.

Laser Surgery
-Through the use of a therapeutic laser beam, the outflow of the aqueous fluid in your eye is improved. Better drainage reduces the "IOP" and saves your sight . Because most forms of Glaucoma cannot be cured, it is likely that you must take medications daily for the rest of your life to maintain your best vi

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Pterygium and Pinguecula

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Pterygia and pingueculae are abnormal growths on the surface of the eye. While most are merely cosmetic imperfections, some pterygia can interfere with vision.

What is a pterygium?
A pterygium is an elevated growth on the cornea. It is an elastic and connective tissue that begins in the inner corner of the eye, and extends toward the center of the eye. It is a result of a process in which the conjunctiva grows into the cornea.

What causes a pterygium?
Why pterygia occur is not totally understood. Long term exposure to sunlight and dry environmental conditions seem to contribute to their development. They appear to develop more often in people who spend a lot of time outdoors. Exposure to sun, wind, dust and or harsh climates are frequently linked to pterygia. They are also found more often in men than women. What are the symptoms of a pterygium? Symptoms may include blurred vision, redness and eye irritation. Most complaints associated with pterygia are itching, burning and scratchiness. While the pterygium is growing, it becomes swollen and red. This growth process is slow, and usually stabilizes without causing problems. Although the symptoms are not severe, growth over any part of the center of the cornea may cause vision loss.

How is a pterygium treated?
If the pterygium does not cause any noticeable symptoms, treatment is not necessary. While it is red and swollen, eye drops and ointments can be used to relieve dryness and inflammation. Once the pterygium begins to threaten vision, it can be removed surgically. Surgery can also be performed for cosmetic reasons. However, pterygia have a tendency to return, especially in younger people. At times, dryness and irritation persists even after removal. Radiation and topical medications can be used to prevent recurrence.

What is a pinguecula?
A pinguecula is the thickening of the conjunctiva on either side of the eye. It appears as a whiteish or yellowish lump, and is composed of benign material. A pinguecula never grows onto the cornea. It is separated from the cornea by normal tissue.

What causes a pinguecula?
Like pterygia, pingueculae are caused by exposure and sunlight. Pingueculae are more frequently found in climates that are warm, dusty and dry. People exposed to the environment are more prone to pingueculae growth. What are the symptoms of pinguecula? For most, pinguecula creates no symptoms. There can be some burning and stinging, however. A pinguecula may become irritated by smoke, dust or wind. It does not interfere with sight, and is considered a cosmetic condition.

How is a pinguecula treated?
In most cases, treatment of a pinguecula is not necessary. Drops can be used to clear any redness of irritation. Surgical removal is rarely medically required. However, a pinguecula may be removed for cosmetic reasons. As with pterygia, pinguecula frequently return after removal.

Prevention is always the best treatment! The eyes should be protected from excessive sunlight and environmental exposure with proper sunglasses. If you are experiencing symptoms of an eye growth or vision problem, please contact our office to schedule an appointment.

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YAG Capsulotomy

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The lens of an eye is made up of two parts: an outer skin and an inner gel-like material. Once the inner area becomes cloudy, it is apparent that a cataract is beginning to form. Cataract surgery acts to remove the cloudy areas and replace them with a lens implant to restore vision. The outer skin, or capsule, remains in place.

What is a secondary cataract?
Due to the natural process of cell regeneration, the capsule can become cloudy as well. This isn't caused by another cataract. Instead, the natural capsule that holds your new lens has become cloudy. It can happen so slowly that years can pass before you realize your reduced vision. Although glasses can help you see better, they may not be enough. Your eyes would then require additional laser surgery to regain lost vision.

What procedure is used?
The process of clearing a Òsecondary cataract is called a posterior capsulotomy or laser posterior capsulotomy. It is virtually pain-free, and is treated on an outpatient basis. The doctor focuses a beam of laser light into the lens implant, creating a tiny opening. This opening clears a path for light to enter into the eye. Multiple applications of the laser, known as a YAG laser, are required to create a new window through which light can pass. The procedure is simple, and usually only takes a few minutes. No needles or stitches are used. Patients' vision is restored soon after the procedure. Pain medication is not required for most. Tylenol¨ and aspirin can be used if necessary for pain.

What is a YAG laser?
YAG stands for yttrium aluminum garnet. This laser produces infrared light impulses to create tiny openings in the targeted tissue by a process called photodisruption. Photodisruption is used to treat secondary cataracts and the iris. It is also sometimes used to help retinal problems in the back of the eye. What are the benefits of YAG laser treatment? Secondary cataract surgery is virtually pain free. Because a laser is used there is less risk of infection and inflammation. The treatment is performed on an outpatient basis. The procedure itself only takes a few minutes. However, the patient will be in the facility for 1-2 hours.

What do I do following surgery?
You will need to do the following:

• Use the eye drops as prescribed
• Be careful not to rub or press on your eye
• Continue normal daily activities and moderate exercise

What are the complications involved?
Bleeding, swelling and retinal detachment are rare but possible complications faced with the laser capsulotomy or any ocular surgery. Notify the office immediately if you experience any of the following after surgery:

• Loss of vision
• Pain that is not relieved by prescribed medications
• Nausea, vomiting or excessive coughing
• Injury to the eye

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Particle Dermabrasion

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Particle Dermabrasion is the newest option for youthful quality skin. It is the right program to fit your cosmetic needs, time, financial requirements and personal preferences.

What is a Particle Dermabrasion?
Particle Dermabrasion is the newest option between beauty therapy and cosmetic surgery. The Diamond dermabrader bombards the epidermal layer of skin with Òmicro crystals to slough off dead skin cells. It leaves the skin fresh and smooth, and promotes new skin and collagen growth. It tightens and rejuvenates sun-damaged skin.

Is the procedure painful?
The process is pain-free, and leaves little or no redness. It is perfect for the busy schedule. Unlike chemical and laser peels, there is virtually no healing process. Patients can return to their active lifestyles immediately after treatments.

What conditions can it treat effectively?
Particle Dermabrasions offer a wide choice to patients that are considering more serious forms of skin peeling, such as chemical or laser.
The peel is used to treat:

• Sun damaged or aging skin
• Acne skin or scars
• Pigmentation marks
• Minimizing stretch marks
• Scars and age spots
• Lips
• Skin and body rejuvenation

What results can be expected?
You will notice an improvement in the appearance of your skin. Acne scars will be less obvious. Age spots and fines lines will be erased. Patients report that their skin feels smoother and younger-looking. The amount of change, however, depends on the area(s) being treated and the number of treatments the patient has undergone. Home care treatments are also an important in maintaining a youthful appearance.

What are the treatments like?
A trained technician administers the treatments. A plastic hand piece acts as a vacuum as it bombards the skin with micro-crystals and lifts away the excess skin. The effect is something like a superficial skin polishing. The procedure takes close to twenty minutes, while still producing satisfying results. Treatments should be repeated on a weekly basis to enhance the skin's condition. It can do what no other available treatment can (without surgery) in combating the signs of aging. It is also safe for all-skin types and colors. The treatment requires no injections.

Why choose Particle Dermabrasions over other procedures?

• They take less time.
• There is little to no discomfort.
• The recovery time is shortened.
• There are no disruptions to normal activities.
• There are no anesthetics required.

Who are Particle Dermabrasions ideal for?
Younger people with early skin changes.

• Active people who don't want interference with their activities.
• Sensitive skin that reacts to chemicals.
• People who cannot afford to take off time for healing from peels and lasers.
• Oily, acne-prone skin that is not improved by acne treatments.
• Patients in good health.
• Men and women who have a good skin tone.
• Patients that have realistic expectations.
  

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Endoscopic Brow Lift

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Fine lines and wrinkles first appear in the brow and forehead area. Cosmetic surgery, such as Endoscopic Browlifts, can smooth out those lines and wrinkles. It can also help correct drooping brows and eyelids, creating a more youthful and appealing appearance!

How are Endoscopic Browlifts performed?
Endoscopic Browlifts, also known as minimal-scar browlifts, are performed using a fiber optic lens that is attached to a camera. It is inserted through half-inch incisions placed in the hairline. This allows for visualization of the surgery as it is shown on a television screen. Additional incisions are made for the insertion of the surgeon's tools. The procedure is viewed on the television monitor, allowing the surgeon to perform the surgery externally. Endoscopic browlifts are especially useful with younger patients, who do not need excess skin removed. Loss of sensation and/or hair at the incision site is minimized. Endoscopics can significantly reduce frown lines in between the eyes. It is frequently performed in conjunction with blepharoplasty, upper eyelid surgery, for optimal results.

What is recovery like?
There is some discomfort following a browlift. There can be swelling and bruising for up to ten days. Some patients will show these signs on the cheeks and eyelids. Patients are instructed to keep the head elevated, and to apply cold compresses to reduce swelling. Once the incisions start to heal, patients will notice some itching and possible numbness. Symptoms such as these will diminish over time. Make-up may be applied three days following surgery. Sutures will be removed between seven to ten days following the operation. Patients are cautioned to avoid any strenuous activity for six weeks.

What are some of the benefits of Endoscopic Browlift surgery?

• Quicker Recovery
• Smaller Incisions
• Minimal Scarring
• Less Hair loss
• Less Bleeding
• Minimal Numbness

Does my insurance cover this procedure?
Most insurance companies do not cover cosmetic procedures. When a browlift is performed to correct a sagging eyelids and/or forehead however, it may be covered in part or wholly by your insurance company. After an initial consultation with our office, we would be glad to check with your insurance provider for prior approval of payment. Upon denial of insurance coverage, we would be happy to set up other payment arrangements. The Initial Consultation Your consultation will include a discussion with the doctor regarding your surgical goals and the probable outcomes of treatment. Photos will be taken to obtain approval from your insurance company for payment by that provider, and to document your before and after results.

Feel free to contact our office to schedule your initial consultation!

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Botox

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(Purified Neurotoxin Complex)
Treatment for Blepharospasm and Fine Lines

What it is:
Botulium Toxin Type A is a protein produced by Clostridium botulinum. Although its uses have been known since the turn of the century, it wasn't until 1980 that the toxin was found to be a valuable tool in helping ophthalmologic disorders. Botox has been used effectively in our office for over a decade.

How it works:
Botox blocks nerve impulses. It binds to the nerve ending and stops the release of muscle activating chemical neurotransmitters. Neurotransmitters are the messengers from the brain that tell a muscle to contract. When the message is blocked, the muscle doesn't contract, preventing muscle spasm. Botox takes full effect within one to two weeks of use. The nerve endings will grow new connections at the muscle sites when not exposed to the Botox. Treatment must be repeated and individualized.

How safe it is:
Botox has been recognized by the American Academy of Neurology, the American Academy of Ophthalmology, and the National Institutes of Health as a safe treatment for blepharospasm from dystonia. For over ten years, thousands of patients testify to the benefits of this product. Botox is an effective and safe ongoing treatment for the relief of symptoms related to blepharospasm. It is important to understand that it is NOT a cure. The degrees of relief will also vary from person to person. Sedentary patients should resume their activities slowly following treatment with Botox. Like all therapies, some patients may experience side effects. The side effects most frequently noted are: ptosis (drooping eyelid, 11%), Irritation around the area injected, tearing, dry eye, lagophthalmos (opening of the eyelid, 10%), or photophobia (light sensitivity, 10%). Less than 1% have experienced ectropion/entropion (outward or inward turning of the eyelid), keratitis (cornea inflammation), or diplopia (double vision). Meanwhile, Botox is generally well accepted by most patients.

If you have any further questions, please consult Dr. Nicolitz at (904) 398-2720.

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Ptosis

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Ptosis is the drooping of the upper eyelid. This may mean only slightly, or it may droop enough to partially and/or completely cover the pupil, leading to the restricting or obscuring of vision.

What is Congenital Ptosis?
Ptosis is sometimes inherited or occurs later in life. When it is present at birth, it is called congenital ptosis. It can be present in either one or both eyes. Congenital ptosis is the result of poor development of the eyelid lifting muscle, or levator.

This type of ptosis requires treatment to allow for normal visual development, and usually does not improve with time. The most serious problem associated with congenital ptosis is amblyopia. Amblyopia is the result of poor visual development in the early years of life. If not treated accordingly, amblyopia will persist throughout the patient's life.

How is Congenital Ptosis treated?
The most effective treatment for ptosis is surgery. The levators are sometimes tightened, or the lid is attached to the brow so that the brow muscles can do the lifting. Depending on the severity of the ptosis, surgery may be required immediately or later in the child's life. Any child showing symptoms of ptosis should be taken to an ophthalmologist for examination.

What is Adult Ptosis?
When ptosis occurs later in life, it is called adult ptosis. The most common cause of adult ptosis is the separation of the levator muscle tendon from the lid. This is usually due to aging or accidental trauma to the eyes. Other reasons include disease of the levator muscle, diabetes or tumors in the levator area.

How is Adult Ptosis treated?
Treatment for this type of ptosis is dependent on the causes of the ptosis. Blood tests, X-rays and other tests are used to plan the best type of treatment. Tightening of the levator muscle or reattachment of the muscle are some common surgical ways adult ptosis is treated. Recovery Surgery lasts about 30-45 minutes. One to two weeks are required for recovery. The bruising and swelling will begin to disappear over this period.

What are the risks associated with Ptosis surgery?
Although negative results are very infrequent, they include infection, blurred vision and/or bleeding. The patient will not be able to fully close their eye following surgery, yet this is commonplace. Perfect symmetry of the eyelids and/or full eyelid movement are sometimes not completely achieved. This can sometimes be corrected with a self-administered eyelid massage or additional surgery.

Prevention
Visual field loss and eyestrain due to ptosis can be easily prevented through annual examinations with an ophthalmologist. Some insurance plans fully cover ptosis corrective surgery on a medically necessary basis.

Please feel free to contact our office to schedule an appointment for a consultation at (904) 398-2720.

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Ectropion

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What is Ectropion?
Ectropion is a medical condition involving sagging and the outward turning of the lower eyelids and eyelashes. The margin of the eyelid essentially everts or turns out. The rubbing that is a result of the condition can cause excessive tearing, mucous discharge, irritation, crusting around the eyelid and/or corneal drying from exposure.

What causes Ectropion?
For most, ectropion is caused by relaxation of the eyelid tissues due to aging. Some are caused by trauma, skin cancer or previous eyelid surgery. In rare cases it is a congenital problem.

How can it be treated?
Surgical intervention prevents excessive exposure and damage to the cornea and conjunctiva. The eye can be taped along with the use of lubricating drops and ointments prior to surgery. For some, sutures can be placed through the lower lid until further surgery can be performed.
The surgery itself is conducted under local anesthesia on an outpatient basis. The eyelid and its attachments are then tightened. The eye will be patched the day of surgery, and use of antibiotic ointment will be necessary. Following the healing process, the eye should feel natural, with no scarring, infection or vision loss. There should also be a sense of increased comfort.

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Blepharoplasty

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Blepharoplasty is plastic surgery of the eyelids. Excess skin and fatty tissue are removed from around the eyes and lids.

Why perform a Blepharoplasty?
Blepharoplasty is done to improve both appearance and visual capability. Excessive overhanging tissue in the upper eyelid area can block the upper field of vision. Even if your vision is not affected, the blepharoplasty procedure can eliminate the saggy, tired look around the eyes. As a part of the aging process, connective tissue and skin around the eyes begin to relax. The normally firm fat pads also push forward, causing bulges or "bags" around the eyes.

When is a Blepharoplasty necessary?
Aside from appearance and vision, excess tissue can also cause discomfort. The weight of excess tissue may cause fatigue and pain in the brow area. Sometimes, lashes will turn inward and irritate the eye. Foreign body sensation and headaches can also occur.

How is the consultation?
For your initial consultation, Dr. Nicolitz will discuss with you the particulars of your condition, your expectations, and the details of your treatment. You will have the opportunity to see before/after shots of other patients, and will have photographs taken of the face for documentation of your results.

What is the procedure?
The doctor needs to determine how much skin and fatty tissue needs to be removed. The upper and lower incision lines are made along the natural folds of the skin to insure that they will be well hidden during and after the healing process. After the excess skin and fat have been removed, the incisions are closed with sutures or tissue adhesive. This is performed on an outpatient basis with a CO2 laser. The patient is given a local anesthesia or IV sedation.

What are the results?
Swelling and bruising may last up to several days, while tearing and blurry vision may also be experienced following the procedure. The incision lines may appear as red marks, but they will fade over time. The scars will become virtually unnoticeable. Rare complications that are sometimes experienced are hemorrhaging, infection, and blindness.
Although the results of such a surgery are generally successful, the outcome is dependent on many factors. These include the extent of reconstructive work done, the healing process and the health of the patient's skin. The benefits and possible complications should be discussed with your doctor prior to surgery.

If you are interested in what this procedure can offer you, please make an appointment with our office for a consultation.

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Endoscopic Brow Lift

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Fine lines and wrinkles first appear in the brow and forehead area. Cosmetic surgery, such as Endoscopic Browlifts, can smooth out those lines and wrinkles. It can also help correct drooping brows and eyelids, creating a more youthful and appealing appearance!

How are Endoscopic Browlifts performed?
Endoscopic Browlifts, also known as minimal-scar browlifts, are performed using a fiber optic lens that is attached to a camera. It is inserted through half-inch incisions placed in the hairline. This allows for visualization of the surgery as it is shown on a television screen. Additional incisions are made for the insertion of the surgeon's tools. The procedure is viewed on the television monitor, allowing the surgeon to perform the surgery externally. Endoscopic browlifts are especially useful with younger patients, who do not need excess skin removed. Loss of sensation and/or hair at the incision site is minimized. Endoscopics can significantly reduce frown lines in between the eyes. It is frequently performed in conjunction with blepharoplasty, upper eyelid surgery, for optimal results.

What is recovery like?
There is some discomfort following a browlift. There can be swelling and bruising for up to ten days. Some patients will show these signs on the cheeks and eyelids. Patients are instructed to keep the head elevated, and to apply cold compresses to reduce swelling. Once the incisions start to heal, patients will notice some itching and possible numbness. Symptoms such as these will diminish over time. Make-up may be applied three days following surgery. Sutures will be removed between seven to ten days following the operation. Patients are cautioned to avoid any strenuous activity for six weeks.

What are some of the benefits of Endoscopic Browlift surgery?

• Quicker Recovery
• Smaller Incisions
• Minimal Scarring
• Less Hair loss
• Less Bleeding
• Minimal Numbness

Does my insurance cover this procedure?
Most insurance companies do not cover cosmetic procedures. When a browlift is performed to correct a sagging eyelids and/or forehead however, it may be covered in part or wholly by your insurance company. After an initial consultation with our office, we would be glad to check with your insurance provider for prior approval of payment. Upon denial of insurance coverage, we would be happy to set up other payment arrangements. The Initial Consultation Your consultation will include a discussion with the doctor regarding your surgical goals and the probable outcomes of treatment. Photos will be taken to obtain approval from your insurance company for payment by that provider, and to document your before and after results.

Feel free to contact our office to schedule your initial consultation!

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Chalazion

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What is a Chalazion?
The term chalazion (pronounced kah-la'-ze-on) comes from the Greek word meaning small lump. It refers to a swelling in the eyelid caused by chronic inflammation of one of the small oil producing glands (meibomian glands) located in the upper and lower eyelids. A chalazion is sometimes confused with a stye, which also appears as a lump in the eyelid. A stye is an acute inflammatory infection of a lash follicle and forms a red, sore lump near the edge of the eyelid.

A chalazion is usually a reaction to trapped oil secretions and not caused by bacteria, although the site can become secondarily infected by bacteria. Chalazions tend to occur farther from the edge of the eyelid than styes (although a gradual swelling can be flat near the edge of the lid), and tend to "point" toward the inside or nose side of the eyelid. Occasionally, chalazion can cause the entire eyelid to swell suddenly.

How is a chalazion treated?
When a chalazion is small and without symptoms, it may disappear without treatment. If the chalazion is large, it may cause blurred vision by distorting the shape of the eye. Chalazions may be treated with any one or a combination of the following methods:

• Antibiotic and/or steroid drops or injections
• Warm compresses. Compresses can be applied in a variety of ways. The simplest way is to hold a clean washcloth, soaked in hot water, against the closed lid for five to ten minutes, three to four times a day. Repeatedly soak the washcloth in hot water to maintain adequate heat.
• Massage or expression of the glandular secretions;
• Surgical removal

Chalazions usually respond well to treatment, although some people are prone to recurrences and may require continuing medication. If a chalazion recurs in the same place, your ophthalmologist may suggest a biopsy to rule out more serious problems.

Why are regular medical examinations important for everyone?
Eye disease can occur at any age. Many eye diseases do not cause symptoms until the disease has done damage. Since most blindness is preventable if diagnosed and treated early, regular examination by an ophthalmologist or optometrist are very important.

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Photo-Refractive Keratonomy and the Excimer

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Refractive Surgery and The Excimer Laser
Performed since the early 1970's, refractive surgery procedures improve vision due to nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. With the advent of the laser for refractive surgery (photo-refractive keratotomy or PRK), a new era in eye care is unfolding. In 1983, it was found that the Excimer Laser could be used to reshape the surface of the cornea.

The Excimer laser is a sophisticated computer assisted instrument which generates a highly concentrated ultraviolet light projected as a column of densely compacted rays. This "cool beam" of light has the ability to precisely reshape the cornea of the eye by vaporizing and removing microscopic layers of soft tissue without affecting adjacent or underlying tissues or cells.

It's Effective
Approximately one million Excimer laser procedures have been performed around the world. Of the patients receiving PRK, 99% have reported an improvement in vision, with 95% reporting 20/20 to 20/40 vision allowing them to legally drive without glasses or contact lenses. The risk of experiencing serious vision-threatening complications is nearly nonexistent. In fact, no patient has ever lost their sight from the PRK procedure.

As with any procedure, PRK does have its limitations and risks. During a consultation appointment with your doctor, expectations and potential complications will be evaluated and discussed thoroughly.

It's Simple
PRK is performed at a state-of-the-art center as an out-patient procedure. One eye is treated at a time. The procedure itself is painless, as a topical anesthetic is used to numb the eye prior to surgery. PRK normally takes less than 15 minutes and the patient leaves shortly after the procedure. An eye patch may be placed on the eye for temporary protection and to keep you from rubbing your eye in your sleep. Medication drops are used for pain relief, to prevent infection and promote healing. After PRK patients usually return to their normal lifestyle quickly with only a few restrictions during the healing period, such as not swimming.

Questions about PRK

Q: Is PRK for everyone?
A: The eye must be in good health and vision must be stable. However, some people are better candidates than others and consultation with the doctor prior to surgery is important to determine estimated benefits and possible complications.

Q: Before I consider PRK, how bad should my vision be?
A: This is a personal decision, assuming you meet all the other criteria. For many individuals, it is a question of whether or not they want to wear glasses, how wearing glasses affects their lifestyle and whether or not they want to wear contact lenses.

Q: Would I need to wear glasses again?
A: Usually not. More than 92 percent of the 200,000 people who have had the Excimer laser procedure are wearing their glasses less than 10 percent of the time.

Q: Is this a permanent procedure?
A: Yes. The results demonstrate that once it heals and is stable, there is a minimal change in refractive error.

Q: When can I go back to work?
A: Most patients are able to return to work in four to five days.

Q: If I have already had radial keratotomy, but am not happy with the results, can I be treated with the Excimer laser?
A: Yes. There have been a number of cases where the Excimer laser has been used to correct residual myopia after PRK.

Considerations and Realistic Expectations
Before you decide to have PRK, it is important that your decision be based on facts and that you understand what PRK may or may not be able to do for you. While results cannot always be guaranteed, the ultimate goal is that PRK will reduce your dependence on glasses or contact lenses, however, in some cases following the procedure you may still need some type of corrective lenses to achieve maximum vision correction. PRK is not a treatment for presbyopia, a condition which is a result of the normal aging of the eye and generally occurs over the age of 40. This condition often requires the use of reading glasses.

Following the procedure, some patients experience varying degrees of discomfort for 24 to 48 hours. During the first few days, you can expect some blurriness in the eye on which the procedure was performed, however, each day will bring improvement. Your doctor will discuss al the benefits as well as the possible risks and side effects with you prior to the procedure.

Ultimately the decision whether or not to have PRK is one only you can make. It is important that you evaluate all the information available to your specific circumstances and discuss with your doctor all the facts related to the PRK procedure so that you can make an informed decision.

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LASIK

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LASIK surgery is a breakthrough technique that frees the average patient from the tedious use of glasses and contact lenses. Imagine being able to do just about everything without having to reach for your glasses or contacts.

What is LASIK?
Using the computer controlled accuracy of the excimer laser, the surface of the eye is reshaped so that images focus more clearly. The procedure offers quick recovery due to the flap of a Lamellar Keratoplasty, and greatly reduces the patient's dependence on corrective eyewear. LASIK is quickly becoming the refractive procedure choice by many refractive surgeons.

Is LASIK right for you?
Although LASIK will reduce your dependence on eyewear, the success of LASIK depends mainly on the patient's eyes. LASIK works well for most people, but the results may not always be 20/20. Some patients over the age of 40 may find that they need to wear reading glasses after LASIK. You may be a good candidate if your vision is stable with or without astigmatism, and you have no other eye problems.

Your Consultation
The doctor will examine your eyes prior to surgery to determine if the LASIK procedure is right for you. You will be dilated, and your refraction will be measured. A Corneal Topography will be taken of your eyes to measure the corneal curvature and contour. These tests will decide whether or not LASIK will be an effective procedure for you.

How is LASIK performed?
LASIK is an outpatient procedure that takes less than an hour to perform. The patient is given anesthesia in eye drop form. Then the doctor lifts a thin layer of your cornea called the corneal cap. The excimer laser radiates your cornea with a high-energy ultraviolet light to reshape it. This alteration correctly refocuses or refracts the light entering the eye, adjusting the level at which you see.

Once the cornea has been reshaped, the corneal cap is replaced to its original position. No stitches are required, and the postoperative discomfort is minimal. Many patients will see a dramatic improvement within the first day. Normal activities can be resumed within a day or two.

Postoperative Directions

• Do Not Rub Your Eyes
• Protect your eyes from getting bumped as it heals.
• Use all medications given to you by the doctor exactly as directed.
• Wear sunglasses when outdoors.
• Return to work as directed by your doctor.
• Don't drive until your vision fully clears.
• Avoid swimming, active sports and wearing eye make-up until approved by your doctor.

How will my Progress be Evaluated?
Your doctor will set-up several follow up appointments to check your healing progress. Depending on the first procedure's effectiveness, a second treatment may be necessary to correct your vision. In some cases, glasses and contact lenses may still be necessary employing a weaker prescription. Since your eyes will be done one at a time, the doctor may wait to see the results of your first eye before proceeding with your other eye.

Will LASIK work for me?
To answer this question, you must first have a complete eye examination to determine your refractive error and the health of your eyes. If you are interested in LASIK, please call our office for your consultation today!

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Prelex

There is a new refractive surgery procedure capable of reducing or even eliminating the need for bifocals and reading glasses for certain categories of patients. This procedure, called PRELEX (for “Presbyopic Lens Exchange”), can reduce or eliminate your need for corrective lenses for distance AND near (reading) vision.

This procedure replaces the imperfect focusing lens inside your eye with a specially designed, multifocal intraocular lens (IOL). The surgical procedure used is identical to the proven safe and effective, out-patient procedure used for cataract surgery for over 25 years. Our practice is now working with the only eye surgeon in our area fully trained and qualified in the use of this procedure for PRELEX. Dr. Nicolitz and his associates and technical office staff have been full trained and certified in PRELEX counseling, surgery and post operative care.

The cost of PRELEX is comparable to other refractive procedures (like LASIK), none of which can correct vision for distance and near. More important, however, is the fact that the other refractive procedures have not been proven effective for the types of vision conditions that PRELEX corrects.

If you would like to consider this new refractive procedure, our office can arrange a complete evaluation and consultation (up to 90 minutes) at no charge to you, whether you proceed with PRELEX or not. We do ask, however, that you please have a serious interest in this procedure if you decide to schedule an evaluation. If you have further questions about PRELEX, you can ask to speak with me directly or our special PRELEX consultant, Dr. Louis Catania.

To help you further in assessing your interest and candidacy for PRELEX, we are including a chart below which includes the procedures positive and negative considerations.

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