Life After Enucleation Surgery: Prosthetic Eyes

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Losing an eye, whether due to an injury, birth defect, or diseases — such as end-stage glaucoma, diabetes, or cancers like retinoblastoma and choroidal melanoma — can be an emotionally and physically traumatic experience. But all hope is not lost. While vision itself cannot be restored in the affected eye, appearance can be, and for most, this is an important aspect of restoring self-esteem.

After the enucleation surgery has been performed to remove the affected eye from the socket, usually keeping the muscles and bone structure intact, a temporary prosthesis is inserted to allow the patient time to heal. A specialist known as an ocularist makes a custom designed artificial eye and can expertly match iris colors to the remaining eye and form the eye shape to the existing socket. Once the inserted, the muscles and blood vessels can conform to the new prosthetic, allowing for both eyes to track objects simultaneously. The result is a restored appearance.

The prosthetic must be checked yearly and polished to maintain it. As age, weight, and movement all affect the eye socket over time, adjustments will need to be made to the artificial eye to keep it in good shape and in good condition. For people who are blind, ocular prosthetics are available. These are similar to contact lenses and are called scleral covers.

Prosthetic EyeProsthetic eyes have been around for a long, long time and, thankfully, have come a long way! The ancient Roman and Egyptian priests in the fifth century B.C. were known to have crafted painted clay eyes attached to cloth that were then worn on the outside of the eye socket. Fast forward several centuries later, and you’ll find the first in-socket artificial eyes made out of gold and colored with enamel. Venetians in the 16th century started making glass eyes and dominated that market until the 18th century, when the Germans perfected the technique. In the United States, glass eyes were made starting in the 19th century but stopped during World War II, as the glass was being imported from Germany, and developed plastic polymers instead. Today, prosthetic eyes are largely crafted from acrylic or silicone polymers as well as glass. With the advent of 3-D printing capabilities, there is hope that prosthetic eyes might one day be able to incorporate Wi-Fi signals and transmit visuals to the wearer.

For more information, visit the websites of the American Society of Ocularists so and the National Eye Institute.

An Overview: Comprehensive Eye Exams

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We have a lot of blog posts here at All About Eyes that mention and/or encourage our visitors to get a comprehensive eye exam. So we thought we take this opportunity to talk about what it is and why it’s important to not just your eye health, but your overall health as well.

The first phase of the comprehensive eye exam focuses on your vision and any issues you may have there. The second phase of the exam evaluates your eye health.

What is a Comprehensive Eye Exam?

At the start of the visit, a technician will have a medical history conversation with you and will perform a pre-test using an autorefraction machine that measures the eyes for the preliminary prescription and also does keratometry, an examination of the curvature of the eye itself. This is useful in determining astigmatism. Then they perform what’s called tonometry with the non-contact tonometer (no drops needed). A tonometer is used to apply a puff of air onto the eye to measure eye pressure and is used to determine if you have glaucoma.

If the results from that test are high, then the doctor will apply numbing drops in the eyes and a further check of the intraocular pressure with an applanation tonometer will happen. Applanation tonometry uses a small lens to rest on the tear film/cornea to check the pressure. This test is usually painless and quick.

The other tests offered during pretesting are the Optomap digital retinal imaging which gives a wider, more complete picture of the retina and can detect problems not seen with the other tests. All About Eyes also uses an ocular coherence tomographer (OCT) which is a non-invasive imaging machine used to check the layers of the retina. It is beneficial for early glaucoma detection and in diagnosing macular problems.

Classic Eye Chart: Comprehensive Eye Exam

A visual acuity test will be given, where you will be asked to read off rows of random letters that gradually decrease in size until you reach a point to where you can no longer read with certainty. Also in included in the visual acuity testing are checking your vision for color blindness (if any) and 3-D testing to check your depth perception.

In the visual mobility tests, your practitioner will use various instruments (lights, eye covers) to see how your eyes are working. They will watch for eye muscle movements, check your peripheral (side) vision, and for your pupils’ response to light. Phoropter: Comprehensive Eye Exam

A phoropter is a refractor machine that determines the lens power needed for glasses (nearsighted, farsighted, and/or astigmatism). The doctor will give you an option of which lens looks clearer (“one or two”) and this helps to set your prescription for glasses or contact lenses if needed.

Slit Lamp: Comprehensive Eye ExamTo look at the back of the eye, the doctor will use a small, high magnification lens in addition to a biomicroscope. The biomicroscope, also called a slit lamp, is used to shine a light onto the eye so that its structure can be examined up close. This binocular microscope looks at all the areas towards the front of the eyes: eyelids, cornea, conjunctiva, iris (colored area), and the lens itself. This test can detect many diseases including cataracts, macular degeneration, corneal ulcers, and diabetic retinopathy. Sometimes dilating drops are necessary during this exam if the patient has tiny pupils, is very light sensitive, or they have retinal problems.

Why are Comprehensive Eye Exams Important?

First and foremost, as the American Optometric Association says, annual comprehensive eye exams can help with early diagnosis of vision issues which can help to prevent vision loss. Quite simply, they help to save your sight.

But, as we talked about in our article, Eye Checkup = Health Checkup, a comprehensive eye exam can also go a long way toward early detection of other major health issues such as stroke, heart disease, and sexually transmitted diseases, to name a few.

So schedule an appointment with either Dr. Dave Roell or Dr. Cheryl Roell today!

Cataracts – Causes and Detection

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Cataracts cause a clouding effect in your vision but fortunately, they can often be corrected with surgery (click here for expanded information on what cataracts are, available treatments, and prevention tips). So, what actually causes cataracts and how can you detect them?

First, the bad news. Cataracts are mostly caused by age and there really isn’t anything any of us can do about that. Time marches on, proteins develop in the eye’s lens, and the cloudiness develops. According to the National Institutes of Health, by age 80, more than half of all Americans will either have a cataract or will have had surgery to remove them.

Sometimes, cataracts are caused by things that aren’t necessarily within our control, like a traumatic eye injury, diseases like diabetes and glaucoma, or in rare cases, you’re born with them or they develop in childhood because they’re congenital. However, cataracts can also be caused by things within our control such as smoking, alcohol consumption, steroid use, and prolonged exposure to sunlight without wearing sunglasses.

Dilated Eye

Dilated Eye

So the good news is, by living a healthy lifestyle, eating plenty of fruits and vegetables, and taking good care of ourselves, we can extend the health of our eyes. Part of taking good care of ourselves is making sure to get yearly eye exams, specifically a comprehensive eye exam, which may include dilation and/or Optomap retinal imaging. This type of exam allows the eye care professional to look deep into the inside of your eye. In a dilated exam, drops are placed in each eye which dilates the pupil (the black dot in the center of the eye), making it larger to allow more light in. A large magnifying lens is then used to see into the back of the eye. Optomap retinal imaging takes a 200-degree image of the back of the eye and often does not require dilation. Both of these tests are important, as they can detect early stages of disease, often before any other warning signs appear.

If you suspect you have cataracts in one or both eyes, make an appointment at All About Eyes. Dr. Dave or Dr. Cheryl will conduct a comprehensive eye exam and discuss cataracts with you in more detail. Give us a call at 609-653-9933 to set up an appointment today.

7 Myths About Lasik that are Absolutely Not True

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This month’s post about the lasik myths is written by a guest blogger and is approved by Dr. Dave and Dr. Cheryl.

blue-eyeClose to 700,000 LASIK procedures are performed every year by qualified eye surgeons.  Even though there have been so many procedures, certain misconceptions about LASIK surgery still remain. We’re going to dispel them right now.

Myth #1 – LASIK is painful

This is one of the biggest myths about LASIK. It comes from a fear of lasers. After all, a laser being used to shape your cornea has got to hurt, right?  In reality, the entire affected area is numbed by special eye drops.  While the doctor is working on your eye you may feel some pressure, but the process is pain-free.

Myth #2 – LASIK is for presbyopia

LASIK is a procedure which has been used on people with nearsightedness, farsightedness, and astigmatism, but it is not completely effective for presbyopia. Presbyopia is caused by the hardening of the eye’s lens, not the shape of the eyes.  Fortunately, presbyopia can be treated with the use of reading glasses and other measures.

Myth #3 – LASIK can cause you to go blind

To date, there have been no cases of blindness which have been associated with LASIK surgery.  In fact, there is only a small chance of any major complications happening after the surgery, and none of them have involved blindness. LASIK only affects the top surface of the eye, not the deeper structures. LASIK is a safe procedure which has been done or at least twenty years.

Myth #4 – After LASIK, you will never need eyeglasses or contacts for the rest of your life

The LASIK procedure is effective for astigmatism, nearsightedness, and farsightedness and can remove the need for prescription lenses. However, it cannot prevent problems which happen over the normal passage of time, like presbyopia.  Other issues unrelated to the shape of the eye can also surface.

Myth #5 – Every LASIK surgery is the same

When planning to get the LASIK procedure done, it’s best to take a look at what you’re getting within the procedure.  There are some ‘no-frills’ doctors out there who offer only the surgery without the aftercare at a cheaper price.  Other doctors offer packages which are more pricey, but all inclusive.  This is your only pair of eyes, so it’s always suggested that you err on the side of caution. Studies show that when adequate pre-care and aftercare are performed, the results are much better.

Myth #6 – The LASIK machine does all the work, not the doctor, so it doesn’t matter which one you choose.

This is much like saying that a piano will sound the same regardless of whether a 3-year-old is playing it or a concert pianist is at the keys.  The surgeon makes the difference in the surgery. The doctor determines where to cut, how to cut, how to create the flap, and a lot of other factors which contribute to a positive outcome.  The doctor is also responsible for the pre-care and the aftercare of the patients. Do your research!

Myth #7 – Everyone can get LASIK

There is an in-depth screening process which most eye doctors go through to determine whether the patient is a good candidate for LASIK.  The patient must be over 18 and display signs of nearsightedness, farsightedness, or astigmatism.  The patient must be in good health and not have any special risk factors. To find out whether you’re a good candidate for LASIK, check with your qualified LASIK doctor.

If you are considering getting LASIK surgery, keep an open mind and be resistant to the many myths which have been floating around about the procedure.  Search for a doctor, ask questions, and make sure that you trust your gut.  Remember that not every doctor is perfect for every patient, so don’t be afraid to keep looking if you don’t like your options.


Emily Hunter is a SEM Strategist and Outreach Supervisor at the Marketing Zen Group and works closely with Eyecare2020. She loves designing strategies with her team and is excited about spreading the Zen gospel. In her spare time, she cheers for Carolina Crown and Phantom Regiment, crafts her own sodas, and crushes tower defense games. Follow her on Twitter at @Emily2Zen