To begin with, a cataract is clouding of a lens in the eye.  Normally the lens is clear, completely see-through.  It helps our eye focus images on the retina.  As we age, the cataract becomes cloudy, yellowish, whitish, or in extreme cases, even brown.  As that happenes the vision starts to get worse.  Here is an image to help you understand cataract a little better:

How can I tell if I am getting a cataract?

Some of the common symptoms of cataracts are :   Gradually declining vision, trouble focusing, sensitivity, not being able to see details of images,   halos or glare, double vision, colors may become dull.  This happens because the light rays entering the eye instead of being focused by the clear lens, are scattered by the now cloudy hardened lens (cataract).  Here is an image to help you understand these symptoms:

At what age should I start worrying about it?

Most age-related cataracts start affecting people after 50 years old.  Although, cataracts before that age are rare , I have seen patients in their forties or even thirties with fairly dense significant cataracts that require surgery.

Is there anything I can do to prevent cataracts from appearing or from getting worse?

While good genetics helps and while there are no medicines that could help with prevention of cataract, a good rule of thumb is to try to stay healthy and to lead healthy lifestyle.  Cataract is simply aging of the lens in the eye, so what is good for your heart is good for your eye as well.  So eat plenty of antioxidants, omega-3 (as in vegetables and fish), avoid smoking, exercise, and protect your eyes from the sun, control diabetes well if you have it, and you will be doing your part in prevention of many eye problems.

When is the right time to have cataract surgery?

Well, that’s a very individual question.  People who work, are active, drive, read, enjoy arts (colors) in general notice declining vision and declining brightness of colors earlier than people who are less active.  The best think to do is establish a good and trustworthy relationship with your New York ophthalmologist early before the cataract becomes significant, so that when the time comes you have a professional you trust on your side.

With warmest regards,

Your Ophthalmologist,    Julia Giyaur, MD

If you are wondering if you may be getting cataract or were recently diagnosed with one and are seeking second opinion for cataract surgery please call us at our New York Eye care locations to schedule your consultation:  718-896-1600.

A 45 year old nurse, Anna K.,  was referred to my practice by another New York ophthalmologist after having LASIK eye surgery at another eye center.  She stated that the surgery went great but that she was still unhappy.  Apparently, she was nearsighted before her LASIK surgery and couldn’t see well far, but was able to read up close without glasses.  After the laser, she sees great far, doesn’t need glasses for walking, driving, or watching moves, but she now can’t read small print up close and needs reading glasses.  How could this happen, she asked me.

The problem is that in people after 40 the power of Accommodation is gradually lost.  So what is Accommodation?  Let us pretend that our eye is like a camera with a powerful zoom lens.  When we look far the lens zooms out and allows us to focus on distant objects.  When we try to focus at something that’s near to us, then the lens has to zoom in and allow our eyes to focus on that near object.  The closer the object the more “zooming in ” our eyes have to do.  Isn’t it a wonderful mechanism that allows our eyes to do this without us even giving it a thought!

Power of Accommodation:

So, what happens after 40?  The zooming in power of the lens in our eyes starts weakening.  So gradually you may start noticing that it is more difficult to read smaller print and you have to keep pushing your arm further and further away.  The near images and letters simply become blurred.  The scientific term for it is Presbyopia.  Unfortunately, all of us will have to go through this at some point in our lives.  This is where nearsighted people have advantage,  since their lens is too strong for their eye, they don’t need the zoom in mechanism to see up close.  They still get Presbyopia, but they can still read up close by taking their glasses off.  Many of my nearsighted patients can read well without glasses well into their fifties or even sixties.

Reading with Presbyopia

So, does this mean that people over 40 cannot or should not get LASEK or LASIK vision correction.  Not at all!!!!  Most of them are just as unhappy about having to wear glasses or contacts as before.  In addition, a lot of them dislike the process of having to take their glasses off to read, so they end up needing bifocal glasses.  To avoid the problem of not being able to read after LASIK, I, and some other New York ophthalmologists offer Laser Vision Correction with Monovision.

So, what is Monovision?  Most of us have only one stronger, dominant eye.  In LASIK/ LASEK with Monovision the dominant eye gets corrected perfectly for distance to give you that better than 20/20 vision, the other eye gets corrected to become just a touch nearsighted and will give you good near vision for many years.  Most of my patients are very happy with Laser Vision Correction with Monovision and are not even aware of the difference between the two eyes.  We are able to achieve such high rates of satisfaction among our patients because we use very individualized approach and offer this method only to qualified patients.  We also offer contact lens trial to allow the patient to “test” or “simulate” Monovision before getting permanent LASIK or LASEK vision correction done.

Monovision:                   

Please email us with questions, or come into the office for your Free Laser Vision Correction consultation!

Enjoy the rest of your New York Summer and summer recess!

As always,

Very truly yours,

Dr. Giyaur

Almost every day I get a patient complaining of seeing spots in their eyes.  Especially in the summer, since it’s bright outside, the sky is blue, and the spots are more noticeable.  Different people describe them differently:  spots, flies, mosquitoes, spiders, and spider webs.  Some patients even draw a picture of what exactly they see.  Some are so distraught by it that it starts affecting their daily lives, others, barely notice them.

We, doctors, like to simplify things, so we call them simply floaters.  Some of us favor Latin name of Muscae volitantes (flying flies) . Almost all of us at some point of our lives will experience these floaters.  So, are floaters harmful, are they a sign of something sinister, will they go away, should you be worried?

What are floaters?

To understand how floaters appear we should first understand the structure of the eye.   The eye is essentially a ball (eyeball!   ) that filled with different types of fluid.  Of course, there are also structures that help us see the wonderful world around us.   Most of the volume of the eye is filled by viscous fluid called Vitreous humour (means “glassy fluid, Latin).  Vitreous is attached to a thin film of nerve tissue in the back of the eye, called retina.  In kids this vitreous is completely jelly-like (imagine clear colorless Jell-O).  As we age, however, the gel starts becoming more liquid.  Parts of the vitreous start contracting and forming whitish strands.  This process is called vitreous syneresis (for Latin language lovers).  Since the whitish strands are inside the eye we don’t see them as white.  Instead we see a shadow of them on our retina:  dark, either black or gray, lines, spots, webs, or various other shapes.  Since we see only shadows of floaters they are more visible in a light environment (against a blue sky, for example).  And of course, since the vitreous gel around the floater gets more liquid with age, these strands move around with eye movements.

As the process continues,  the vitreous gel shrinks even more and separates from the retina in the back of the eye (usually after the age of 50 y/o).  You may see some flashing lights and a larger floater may appear.  This is called Posterior Vitreous Detachment.  If you haven’t seen an ophthalmologist already, this is definitely a reason to see one urgently (see below).

Are Floaters Harmful?

Floaters are generally not harmful to your vision.  However,  occasionally, as this vitreous gel, liquefies, and separates from the retina,  it pulls of a peace of retina with it creating a retinal tear or hole.  Some people may see a flashing light when this happens.  Retina is a very important part of the eye.  Problems with retina are a serious matter, can lead to loss of vision, and need to be addressed right away.  For that reason, I strongly recommend seeing an ophthalmologist for any new floaters or any changes in the pattern of floaters, and, definitely, if you are seeing any flashes or sparks in your eye ( I mean, actual sparks, not figurative ones).  Most of the time, you will walk out with a reassurance that everything is OK. Your ophthalmologist will continue seeing you once in a while to make sure your eyes remain healthy.  Occasionally, a retinal hole or tear may be discovered that may require laser treatment.  Rarely, usually when floaters and flashing lights are ignored for some time,  a person may actually have a more vision-threatening problem, retinal detachment, that may require eye surgery and may result in permanent loss of vision.

Will Floaters Ever Go Away?

Most people once they see floaters for the first time, will continue to see them at least once in a while.  Our bodies, however, have a wonderful ability to get used to things.  Overtime, your brain will learn to ignore the floaters, and while you will still notice them occasionally, they will not bother you as much.   A visit to an ophthalmologist also helps.  Reassurance that your eyes and your retina are OK works magic, in this case, to help a person deal with and get used to floaters.

In short, most of us will see floaters at one point or another and for most of us they are completely harmless.  However, if you are seeing floaters or flashing lights and you haven’t seen an eye doctor yet, please, don’t ignore your eye health, see your ophthalmologist.

Have a wonderful New York summer and don’t forget your sunglasses!

Dr. Julia Giyaur

Some of my patients active in sports wonder, does having Laser Vision Correction weaken the wall of the eye, and make the eye more susceptible to injury during sports?   My answer to that is:   that depends.

During traditional LASIK or I-LASIK the cornea is initially cut to create a flap, laser treatment is then carried out under that flap.  Following the procedure the flap is placed back into its original place.  The problem with this method is that although the surface cells of the flap do grow back,  the actual flap itself never heals completely,  so the wall of the eye is weaker than it was before the procedure, and flap can dislocate even months or years later.  Most of the complication of traditional LASIK are related to the flap.  Because of this, US military does not recommend traditional LASIK to its recruiters.  But since, wearing glasses or contacts is dangerous in training or during combat, US government does encourage their recruiters to get Laser Vision Correction (US Army even pays for it).  The procedure that army recruits get almost exclusively is LASEK.

LASEK is a modification of the older, tried and true, procedure called PRK.  In LASEK, no flap is created, instead I use a special solution to weaken and remove a few superficial layers of cells from the surface of the cornea.  The laser part of the procedure is the same as in LASIK:  Excimer Laser is used to reshape the cornea to correct nearsightedness, farsightedness, and astigmatism.  In LASEK there is no cut in the cornea at all, and all flap-related complications are eliminated!  The cells that were removed during the procedure heal back within a few days and patient can enjoy beautiful clear vision without glasses or contacts.

Our practice is the only practice in Brooklyn and Queens area, and one of few in the entire NYC area, that specializes exclusively in non-cutting laser vision correction, LASEK.  We believe, that any intervention and surgical procedure should be first of all safe in the long run!  Since most of our vision correction patients are young and very active in sports, we switched from traditional LASIK to the safer non-cutting procedure, LASEK.

So to make the long answer short, enjoying sports activities, such as soccer, basketball, baseball, tennis, martial arts, and others is very safe after LASEK vision correction since there is no flap created and the eye stays strong and intact.  Some of our patients report that they are actually better more confident players after LASEK, since they see better than before, and they are not worried about breaking there glasses or loosing or getting infection under their contacts.

You can learn more about laser refractive surgery by visiting Laser Vision correction page of our website, and scheduling your consultation with us.  (Free consultations are available)

Enjoy watching the 2010 FIFA World Cup South Africa!

Julia Giyaur, MD

Myopia  or Nearsightedness :  The person can see well at near but not far.  The eye is usually longer, or the cornea is steeper and the images are focused in front of the retina instead of on the retina.  “”Minus” lens is usually needed to bring the image into focus.

Hyperopia or Farsightedness : The person can see well far but not near usually, however, with age both near and far vision may become affected.  The eye is usually shorter, or the cornea is flatter, and the images are focused behind the retina.  “Plus” lens is needed to correct the problem and bring the image into focus. 

Astigmatism: The cornea is more curved in one direction that in another, kind of like a football.  So as a result patients frequently get distortion of there vision, kind of like looking through a fun house mirror.  Both distance and near vision may be blurry.  Astigmatism is often accompanied by either nearsightedness or farsightedness, and requires a special lens for correction.

Presbyopia: Decline in near vision that happens with age as the eye stats to loose its ability to “zoom in” at near.  Most people with normal vision will notice decline in near vision after the age of 40.  You may begin to find that you need to start holding the book further away from your face in order to see properly.   This familiar even maybe the first sign presbyopia, which, if not treated on time, may cause eye strain, fatigue, and headaches.  Reading or Bifocal glasses may be prescribed.

Refractive Error Correction

There are several ways to correct refractive errors that are available today.

• Glasses – the most common, safe, easy, and simple method of correcting all types of refractive problems.  There are significant disadvantages to wearing glasses:  discomfort, fogging, inability to do certain activities (swimming etc),   cosmetic, and cost.

• Contact lenses - very common method of correction of nearsightedness, less commonly used to correct farsightedness and astigmatism, and rarely used to correct presbyopia.  Had cosmetic and comfort advantages over glasses.  However, has significant disadvantages:   increased risk of infections and allergies especially with long term wear and improper care;  risk of corneal scarring and cornea not getting enough oxygen;  causes dry eye,  eye redness, and irritation;  use is commonly limited to 10-15 years, after which time patients usually have to limit wear or stop wearing contacts all together due to all of the above; inability to do certain activities, sa swimming; cost.

• Laser Vision Correction (LASIK, LASEK, and Epi-LASIK) – is becoming more and more popular in US and other developed countries.  The cornea is reshaped with the excimer laser correcting nearsightedness, farsightedness, astigmatism, and even presbyopia.  With today’s technology, vision resulting after the procedure is sharper, better than with either glasses or contacts.  We specialize in cut-free LASEK and Epi-LASIK, in which the cornea does not get cut at all and no flap is created.  By using a special gentle solution to prepare the cornea for laser we eliminate the need for all cutting used in traditional LASIK (or I-LASIK), making the procedure 10x safer.  I consider this procedure much safer than long term contact lens use, and actually underwent the procedure myself early this year.  The advantages of the procedure are better vision, permanent correction, comfort, and safety over contact lenses.  Some of the disadvantages include having to undergo a procedure, concerns over safety, and initial cost (not a singificant issue since most patients end up spending more than that in a few years on glasses, contact, solutions etc)  Please read more about it on my website  www.NYLaserVision.com.

• Intraocular Lens implants or IOLs (ReZoom, ReStor, Technis multifocal) – along with laser vision correction are becoming more and more popular in US for correction of all types of refractive errors.  Is usually a preferred method of correction after the age of 50 because these lenses have an advantage of correcting presbyopia and restoring youthful vision to our older patients.  To learn more about IOLs please go to our website www.NYLaserVision.com.

• Phakic intraocular lens implants - are usually used in younger patients to correct very high nearsightedness, or farsightedness.  Surgical procedure in which the lens gets inserted into the eye and attached to the structures within the eye.