DOCSLIB.ORG

Irregular Astigmatism and Higher-Order Aberrations in Eyes with Dry Eye Disease

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Irregular Astigmatism and Higher-Order Aberrations in Eyes with Dry Eye Disease Special Issue Irregular Astigmatism and Higher-Order Aberrations in Eyes With Dry Eye Disease Shizuka Koh1,2 1Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan 2Department of Ophthalmology, Osaka University Graduate School of Medicine, Osaka, Japan Correspondence: Shizuka Koh, De- Visual disturbances were included in the definition of dry eye disease in the 2007 Dry Eye partment of Innovative Visual Sci- Workshop report. As a result, quality of vision (QoV) in dry eye patients has received ence, Osaka University Graduate increased attention. Corneal topography and wavefront sensors have been used to objectively School of Medicine, Room E7, 2-2 and quantitatively evaluate optical quality, with data showing increases in irregular Yamadaoka, Suita Osaka, 565-0871, astigmatism and higher-order aberrations (HOAs) in dry eye patients. Furthermore, ocular Japan; optical characteristics are influenced by the tear film, which constantly fluctuates over time. [email protected]. Therefore, dynamic quantitative assessments of optical quality with continuous measure- Submitted: November 28, 2017 ments are essential to understanding QoV in dry eye patients. This review summarizes what is Accepted: March 12, 2018 known and what advances have been made in evaluating and understanding QoV in dry eye patients. In particular, corneal topographic and wavefront analyses, conducted both overseas Citation: Koh S. Irregular astigmatism and in Japan, are described. and higher-order aberrations in eyes with dry eye disease. Invest Ophthal- Keywords: irregular astigmatism, higher-order aberrations, dry eye, corneal topography, mol Vis Sci. 2018;59:DES36–DES40. wavefront sensor https://doi.org/10.1167/iovs.17-23500 he tear film greatly influences ocular optics because it is the optical quality are of particular importance for better under- T first refracting surface that light comes into contact with. standing and treating dry eye disease.4 This may seem obvious, but the influence of the tear film on optical quality and visual function has not been discussed in great detail in eyes with dry eye. This is likely because most dry RECENT PROGRESS AROUND THE WORLD eye patients have a good best-corrected visual acuity, with the exception of advanced or severe cases (e.g., Sj¨ogren’s syndrome Corneal Topographic Analyses and Steven–Johnson syndrome). Visual acuity measurements Corneal topographic analyses are used to detect corneal have become the hallmark of visual function. Unfortunately, irregular astigmatism. Conventional Placido ring–based corneal these conventional assessments do not detect all aspects of topographers measure anterior corneal surface contours7 by degraded visual function. In the early 1990s, Rieger1 first analyzing reflected images of a ring projected onto the air–tear demonstrated the importance of the tear film in vision by film interface. Therefore, this system is capable of detecting comparing vision and static perimetry results in patients with tear film–related changes in corneal topography. Several studies dry eye. Thereafter, the effect of the tear film on contrast have indicated that fluctuations and irregularities in the tear 8–10 sensitivity has been the focus of investigations, as this film increase irregular astigmatism. Previous studies on eyes 11–13 subjective measurement more accurately reflects visual perfor- with dry eye have measured surface regularity index (SRI) mance.2,3 and surface asymmetry index (SAI) to better understand local The development of refractive surgery marked a major corneal variations. These studies showed that both SAI and SRI turning point in ophthalmology. Successful refractive outcomes were higher in dry eyes than in healthy eyes. High-speed relied on understanding quantitative quality of vision (QoV) videokeratoscopy was also recently developed to document and assess dynamic corneal topography changes associated evaluations and not just conventional visual acuity testing 14–18 results. As a result, remarkable advances in objective QoV with precorneal tear film behavior. assessments have been made, including the development of corneal topography systems and wavefront sensors. Notably, Wavefront Sensing QoV assessments are also applicable to ophthalmology fields Wavefront sensing measures the refractive status, including other than refractive surgery. Corneal topography systems and irregular astigmatism, of the eye’s whole optical system.19,20 wavefront sensors are now widely used in clinical practice to The wavefront sensor detects and quantifies irregular astigma- objectively and quantitatively assess optical quality. These tism as higher-order aberrations (HOAs). Exploding interest in measurements revealed an increase in irregular astigmatism QoV and how it relates to wavefront analyses indicates the new and have facilitated further study on how tear film behavior trend of focusing on the tear film. Wavefront sensors are relates to QoV in dry eyes.4,5 Dry eye is a multifactorial disorder sensitive enough to objectively quantify increases in HOAs that of the tear film and ocular surface that results in discomfort, occur with tear film fluctuations.21–24 visual disturbance, tear film instability, and, potentially, ocular Wavefront analyses have utilized the same technologies and surface damage.6 Therefore, advances in objectively assessing analysis methods as corneal topographic analyses. Sequential Copyright 2018 The Authors iovs.arvojournals.org j ISSN: 1552-5783 DES36 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Downloaded from iovs.arvojournals.org on 09/29/2021 Optical Quality in Dry Eye IOVS j Special Issue j Vol. 59 j No. 14 j DES37 FIGURE 1. Representative color maps obtained using a tear film stability analysis system (TSAS). Maps from a normal subject (A) and a dry eye patient (B) are shown for comparison. Image collection began immediately after the patient was asked to blink. The time of image capture is shown in the bottom left corner of each image. Additionally, the bottom right image in each figure part shows how the surface regularity index (SRI, blue) and the surface asymmetry index (SAI, red) changed over time. Reprinted with permission from Kojima T, Ishida R, Dogru M, et al. A new noninvasive tear stability analysis system for the assessment of dry eyes. Invest Ophthalmol Vis Sci. 2004;45:1369–1374. Copyright Ó 2004 ARVO. corneal wavefront aberration measurements (not whole-eye (i.e., TSRI and TSAI, which were derived from SRI and SAI, HOAs) were made in and compared between normal and dry respectively). They found that both TSRI and TSAI were eyes.25,26 Additionally, several Japanese studies (fully described significantly greater in dry eyes than in normal eyes (Fig. 1). below) have examined how HOAs of the whole eye change in Additionally, the insertion of punctal plugs to treat dry eye was connection with postblink changes to tear film dynamics. associated with a significant decrease in both SRI and SAI.35 These sequential wavefront measurements revealed that 27–31 dynamic tear film changes affect postblink optical quality. Wavefront Sensing Additionally, French researchers found that the progression index for corneal HOAs was correlated with subjective, patient- Interest in wavefront analysis has been growing worldwide. 36 reported visual outcomes in subjects with dry eye.29 They also Koh et al. quantified the optical impact of tear film breakup found that optical quality degradation in dry eyes is associated for the first time using a wavefront sensor from Japan. This with visual impairment during driving.30 Furthermore, simul- study confirmed that physicians need to perform careful taneous evaluation of ocular HOAs and tear meniscus preoperative wavefront measurements before refractive sur- dimensions makes it possible to investigate the influence of gery to avoid the effects of tear film breakup. real-time tear film changes, including tear volume, on optical The introduction of sequential measurements of corneal quality.31 wavefront aberration allowed the postblink changes in HOA to be quantified over time.25,26 This, in turn, led to a better understanding of how the tear film influences QoV. Koh and 37–40 41 RECENT PROGRESS IN JAPAN colleagues (Koh et al., Mihashi et al., and Hirohara et al.42) specifically examined sequential ocular wavefront Corneal Topographic Analyses aberrations and the optical effect of tear film dynamics after blinking. They introduced the following quantitative indices Attention to assessing corneal irregular astigmatism induced by that describe sequential HOA change over time: the total HOA tear film changes has increased around the world, including in fluctuation index (FI) and stability index (SI). Both FI and SI are 32 Japan. Goto et al. reported an increase in SRI after sustained useful in describing time-dependent HOA changes that cannot eye opening in dry eyes, but not in normal eyes. After this be detected with a single measurement.37 FI and SI measure- study was done, tear film stability analysis system (TSAS) ments can now be performed in the clinical setting, because software was developed for the TMS-2N corneal topography the Hartmann-Shack wavefront aberrometer developed in their instrument (Tomey Technology, Nagoya, Japan). This new study was used as the prototype for the commercially available software gave the system the ability to capture serial corneal KR-1W (Topcon Corp., Tokyo, Japan). surface images once a second for 10 seconds. Using
Load more

Recommended publications
  • Fact Sheet: Refractive Errors
    Fact Sheet: Refractive Errors More than 11 million Americans have common vision problems that can be corrected with the use of prescriptive eyewear such as glasses or contact lenses.1 These conditions are known as refractive errors and they occur when the eye doesn’t correctly bend, or ―refract,‖ light as it enters the eye. Common refractive errors include the following: o Nearsightedness (also called myopia)—A condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. o Farsightedness (also called hyperopia)—A common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. o Astigmatism—A condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. o Presbyopia—An age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Refractive errors are one of the most common—and correctable—causes of visual impairment in the United States. According to a recent study led by the National Eye Institute (NEI), approximately half of all American adults don’t have the 20/20 vision physicians consider optimal due to refractive errors.2 Women experience refractive error more frequently than men: Twenty-six percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older.
    [Show full text]
  • Managing a Patient with Post-Radial Keratotomy and Sjogren's Syndrome with Scleral Contact Lenses
    Managing a patient with Post-Radial Keratotomy and Sjogren's Syndrome with Scleral Contact Lenses Case Report 1 Candidate #123 Abstract: Surgeons used radial keratotomy (RK) in the past as an attempt to flatten the corneal shape and reduce refractive myopia in a patient. In the present day, many post-RK patients suffer from poor, fluctuating vision due to an irregular corneal shape induced from this procedure. Rigid gas permeable lenses, such as scleral lenses, are an excellent solution to improve and stabilize vision. Scleral lenses help recreate an optimal refractive surface to enhance vision for the patient. Patients with specific dry eye symptoms can receive a therapeutic benefit from scleral lens use as the lens acts as a protective barrier for corneal hydration. This is a case report on a patient suffering from both ocular and systemic conditions resulting in decreased vision and discomfort from severe dry eye. She has been successfully fit with scleral lenses to improve signs and symptoms. Key Words: Radial keratotomy (RK), dry eye, Sjogren's syndrome, scleral lens 2300 East Campbell Avenue, Unit 316 Phoenix, AZ 85016 [email protected] (480) 815-4135 1 Introduction: Patients may present to their eye care provider with multiple conditions impacting 2 both their ocular and systemic health. Ocular comorbidities frequently lead to visual impairment 3 and decreased quality of life. To suitably manage these coinciding ailments, it is essential to 4 obtain an early and proper diagnosis. [1] In some instances, similar approaches can help alleviate 5 patient symptoms in managing these comorbidities. 6 7 The goal of refractive surgery is to eliminate the dependency on glasses and contact lenses.
    [Show full text]
  • Scleral Lenses to Manage Dry Eye Symptoms
    Contact us today Scleral Lens for Management of to learn how scleral lenses Dry Eye Symptoms can make a difference in your life. Affix your practice address label here. Scleral lens vaulting the cornea, maintaining a cushion of tears. Blanchard Contact Lenses supplies the specialty GP lens industry with leading lens designs of the highest quality. Our mission is to consistently design and develop innovative specialty GP lenses utilizing cutting edge manufacturing methods, while maintaining unique partnerships with eye care professionals to improve all aspects of the contact lens wearer experience. Scleral Lenses for the Management of Dry Eye Symptoms Chronic Dry Eye Disorders Dry eye can occur or be caused by How msd™ and Onefit™ Scleral Lenses Work According to a consumer survey1, many conditions. Some are: 48% of adults report dry eye msd™ and Onefit™ scleral lenses are • Age related symptoms. Of those, 42% have made of materials that let oXygen pass • Gender (occurs more with women) trouble reading print as a result of dry through the lens promoting long term eye. Nineteen percent report using • Medications and/or medical conditions cornel health and comfort. The lens over the counter drops to help with • Environmental conditions design provides a thin cushion of fluid the condition, but two thirds of those • Post Refractive Surgery (LASIK and that stays between the lens and eye who use drops find that they are not msd™ Mini-Scleral Lens RK), post-surgery, or post-injury providing immediate relief of dry eye comfortably fit to eye. effective. symptoms and long term wearing Patients with dry eye symptoms may comfort.
    [Show full text]
  • Refractive Status and Optical Components of Premature Babies with Or Without Retinopathy of Prematurity at 7 Years Old
    116 Original Article Refractive status and optical components of premature babies with or without retinopathy of prematurity at 7 years old Yang Wang, Lian-Hong Pi, Ru-Lian Zhao, Xiao-Hui Zhu, Ning Ke Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China Contributions: (I) Conception and design: Y Wang, LH Pi, N Ke; (II) Administrative support: LH Pi; (III) Provision of study materials or patients: LH Pi, N Ke; (IV) Collection and assembly of data: Y Wang, RL Zhao, XH Zhu; (V) Data analysis and interpretation: Y Wang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ning Ke. Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China. Email: [email protected]. Background: This study aimed to investigate the refractive status and optical components of premature babies with or without retinopathy of prematurity (ROP) at 7 years old and to explore the influence of prematurity and ROP on the refractive status and optical components. Methods: From January 2009 to February 2011, premature babies receiving fundus photographic screening (FPS) were recruited and divided into non-ROP group and ROP group.
    [Show full text]
  • Refractive Errors a Closer Look
    2011-2012 refractive errors a closer look WHAT ARE REFRACTIVE ERRORS? WHAT ARE THE DIFFERENT TYPES OF REFRACTIVE ERRORS? In order for our eyes to be able to see, light rays must be bent or refracted by the cornea and the lens MYOPIA (NEARSIGHTEDNESS) so they can focus on the retina, the layer of light- sensitive cells lining the back of the eye. A myopic eye is longer than normal or has a cornea that is too steep. As a result, light rays focus in front of The retina receives the picture formed by these light the retina instead of on it. Close objects look clear but rays and sends the image to the brain through the distant objects appear blurred. optic nerve. Myopia is inherited and is often discovered in children A refractive error means that due to its shape, your when they are between ages eight and 12 years old. eye doesn’t refract the light properly, so the image you During the teenage years, when the body grows see is blurred. Although refractive errors are called rapidly, myopia may become worse. Between the eye disorders, they are not diseases. ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. Lens Retina Cornea Lens Retina Cornea Light rays Light is focused onto the retina Light rays Light is focused In a normal eye, the cornea and lens focus light rays on in front of the retina the retina. In myopia, the eye is too long or the cornea is too steep.
    [Show full text]
  • Distribution of Anterior and Posterior Corneal Astigmatism in Eyes with Keratoconus
    Distribution of Anterior and Posterior Corneal Astigmatism in Eyes With Keratoconus MOHAMMAD NADERAN, MOHAMMAD TAHER RAJABI, AND PARVIZ ZARRINBAKHSH PURPOSE: To investigate the magnitude, with-the-rule ERATOCONUS (KC) IS A PROGRESSIVE, USUALLY (WTR) or against-the-rule (ATR) orientation, and vec- bilateral ectatic corneal disorder, characterized by 1,2 tor components (Jackson astigmatic vectors [J0 and J45] K corneal thinning and protrusion. KC starts at and blurring strength) of the anterior and posterior puberty and progresses to the third or fourth decade of corneal astigmatism (ACA and PCA) in patients with life, causing myopia and astigmatism, which results in keratoconus (KC) in a retrospective study, and to try to severe vision distortion and sometimes even blindness.1 find suitable cutoff points for ACA and PCA in an Astigmatism is a refractive error that is mostly caused by attempt to discriminate KC from normal corneas. toricity of the anterior corneal surface leading to visually DESIGN: Retrospective age- and sex-matched case- significant optical aberration. Both the anterior and poste- control study. rior corneal surfaces contribute to the total corneal METHODS: Using the Pentacam images, the aforemen- astigmatism. Recently, the direct and quantitative mea- tioned parameters were compared between 1273 patients surement of the posterior corneal measurements in a with KC and 1035 normal participants. clinical setting has been possible with new imaging tech- RESULTS: The mean magnitude of the ACA and PCA nologies such as slit-scanning, Scheimpflug, or optical was 4.49 ± 2.16 diopter (D) and 0.90 ± 0.43 D, respec- coherence devices.3,4 tively. The dominant astigmatism orientation of the Assessment of the corneal astigmatism plays an impor- ACA was ATR in KC patients and WTR in normal par- tant role in vision correction procedures such as rigid gas- ticipants (P < .001), while for the PCA it was WTR in permeable lens prescription or intraocular lens (IOL) im- KC patients and ATR in normal participants (P < .001).
    [Show full text]
  • Managing Postoperative Astigmatism in Cataract Surgery: a Short Review
    Acta Scientific Ophthalmology (ISSN: 2582-3191) Volume 3 Issue 8 August 2020 Review Article Managing Postoperative Astigmatism in Cataract Surgery: A Short Review Mohammed Abdulkarem* and Mustafa Ali Shata Received: July 20, 2020 Department of Ophthalmology, Jeddah Eye Hospital, Saudi Arabia Published: July 25, 2020 *Corresponding Author: Mohammed Abdulkarem, Department of © All rights are reserved by Mohammed Ophthalmology, Jeddah Eye Hospital, Saudi Arabia. Abdulkarem and Mustafa Ali Shata. DOI: 10.31080/ASOP.2020.03.0148 Abstract Cataract surgery is no more a visual rehabilitation surgery. Today along with cataract removal, astigmatism correction has become a routine procedure. Patients want a spectacle free life at any stage of life. 10 years before it was still impressive to have a residual of +2.0 D astigmatism following cataract surgery. But in last 10 years, a lot of technological advancement has happened. The residual astigmatism following cataract surgery has come down from 1.5D to 0.75D, even 0.5D when a premium IOL is implanted. Here we are going to discuss in short the journey of astigmatism correction from choosing the incision in steep axis to Toric IOL implantation and so on. Keywords: Astigmatism; Surgery; Limbal relaxing incisions (LRI) Introduction Again the closer the incision is from visual axis, the more it causes astigmatism. As the cornea is more of oval in shape, so any incision Cataract surgery has evolved a long way from being simple lens in superior cornea is nearer to visual axis than temporal cornea. So extraction to refractive procedure. Now a days patients wants a superior incisions tends to produce more astigmatism than tempo- spectacle free life following cataract surgery.
    [Show full text]
  • Correcting Astigmatism During Cataract Surgery
    Page 12 | Volusia Health Care News | Fall 2011 | East Volusia County Edition EYE SURGERY Correcting Astigmatism During Cataract Surgery Patients already undergoing cataract surgery to remove cataracts have the option to have toric lens implants placed into the eyes to treat astigmatism and improve vision. ot too long ago, Esperanza Quincy could barely see her surroundings. The 67-year-old Nretiree discovered she had cataracts dur- ing an appointment with her eye doctor. Once employed at a company that made business signs, Esperanza now found her- self unable to even see road signs. “My vision was getting worse,” shares Esperanza. “It was very difficult to see, especially at night. Even while wearing my glasses, it was never good.” Q. JOCELYN GE, MD, PHD implant can often be used as a treatment.” minutes, and there was no pain,” she says. That’s why our patients are happy.” Esperanza’s optometrist informed her The procedure to place the toric lens Esperanza noticed results immedi- Esperanza can’t agree more. that she would need surgery if the cata- implant is not significantly longer than ately after her surgery. “Dr. Ge is an excellent ophthalmolo- racts became severe. regular cataract surgery. Before surgery, the “It’s unbelievable!” she raves. “I can gist and shows concern for her patients,” “The last time I went to see him was in exact location of the patient’s astigmatism read and it’s wonderful! I love to spend she says. “I would recommend Premier January, and he told me my cataracts were is pinpointed, mapped, and measured. time on my computer, and I can now see Eye Clinic to everyone.
    [Show full text]
  • Risk Factors in Amblyopia
    Eye (1990) 4, 787-793 Risk Factors in Amblyopia JOHAN SJOSTRAND and MATHS ABRAHAMSSON Goteborg, Sweden Summary Any intervention to prevent serious amblyopia is based on the knowledge about normal versus subnormal visual development. Our ability to predict with high degree of certainty which children will develop amblyopia will be dependant on the characteristics of various risk factors for initiating the development of squint or amblyopia. We have used longitudinal studies of population based cohorts of young children to define some of these risk factors such as refractive errors. Three hundred and ten children with an astigmatism:;:,:1. 0 D at one year of age were refracted yearly between the age one and four years. Astigmatism and anisometropia were found to be highly variable during infancy and early childhood. Longitudinal follow-up seems to be needed to separate the normal from the abnormal refraction development, which initiates the development of the amblyopia. Children with constant or increas­ ing astigmatism or anisometropia between one and four years were 'at risk'. In parallel we have studied important factors for successful treatment of amblyo­ pia. Based on these findings we conclude that a population screening at four years of age seems to be advantageous in Sweden in order detect and successfully treat most cases of amblyopia. Any intervention to prevent serious amblyo­ uations of the efficiencyof the screening pro­ pia has to be based on our knowledge about grams are few.! An abundant literature normal versus abnormal visual development. describes that the three main causes of I will specificallyfocus on the refractive errors amblyopia are strabismus, refractive errors as key factors for initiation of amblyopia.
    [Show full text]
  • Capturing Patient Opportunity
    Capturing THE PRESBYOPIC Patient ASTIGMATIC Opportunity Using Innovative Contact Lens Technologies for Practice Success driving laptop smartphone stability clear vision comfort FEATURING Paul M. Karpecki, OD, FAAO Moderator Gina Wesley, OD, FAAO Arthur Epstein, OD, FAAO Kerry Giedd, OD, MS, FAAO Mile Brujic, OD, FAAO I. Ben Gaddie, OD, FAAO SPONSORED BY Capturing the Presbyopic Astigmatic Patient Opportunity Contents EMBRACING TECHNOLOGY TO INVIGORATE THE PRACTICE Using advanced contact lens technology to energize patients and the practice ......................................... 3 CONTRIBUTORS .................................................................................................................................................... 3 PRESBYOPIC ASTIGMATS IN CONTACT LENSES: THE OPPORTUNITY A look at the room for growth in contact lenses for presbyopic astigmats.................................................. 4 INTEREST IN CONTACT LENSES AND BARRIERS FOR PRESBYOPIC ASTIGMATS Exploring the disparity between interest in contact lens wear among presbyopic astigmats and the perceived barriers ..............................................................................................................................................5 THE STATE OF VISION CORRECTION AMONG PRESBYOPIC ASTIGMATS The modalities used by presbyopic astigmats and recommended by ECPs today ...................................... 6 ISSUES OF VISUAL, OCULAR, AND PHYSICAL COMFORT FOR PRESBYOPIC ASTIGMATS What the latest research says about digital eyestrain and
    [Show full text]
  • Macular Degeneration
    THOMAS L. LAWRENCE, M.D. Dr. Lawrence is an outstanding ophthalmologist specializing in MACULAR state-of-the-art cataract surgery and laser vision correction as well as glaucoma and general DEGENERATION ophthalmology. He graduated with Age Related Macular Degeneration highest honors from Wheaton College and received his medical AMD degree from the University of Texas Medical Branch in Galveston where he graduated in the top five percent of his class. Following his internship at Baylor College of Medicine, Dr. Lawrence completed his ophthalmology residency at the University of Texas Medical Branch in Galveston. After practicing for 5 years at the world renowned St. Lukes Cataract and Laser Institute in Tarpon Springs, Florida, Dr. Lawrence came to Tallahassee in 1998. He performs state-of-the-art no needle, no stitch, no patch, small incision cataract surgery with optional astigmatism correction and distance/near premium implants. Dr. Lawrence loves Tallahassee and enjoys tennis, hunting and golf. Married to his wife, Penny, more than 40 years, they treasure their 2 daughters, 7 grandchildren, and one great-granddaughter. Preaching at his church on occasion, you will find Dr. Lawrence to be relaxed, informative and A Deterioration of the Retina personable. Which Causes Poor Central Vision Thomas L. Lawrence, M.D. EYES 4 YO U a ~~~, I Apalachee Pkwy. Hwy. 27 (850) 942-EYES 3401 Capital Medical Blvd. 3401 Capital Medical Blvd. www.tomlawrencemd.com Tallahassee, FL 32308 (850) 942-3937 www.tomlawrencemd.com acular degeneration (also called age What is the macula? related macular degeneration or The macula is a very small area of the M AMD) is the leading cause of im­ retina which is responsible for cent~ vision paired reading or detailed vision.
    [Show full text]
  • Management of Astigmatism in Cataract Surgery
    Management of Astigmatism in Cataract Surgery Jonathan B. Rubenstein, MD Vice-Chairman and Deutsch Family Professor of Ophthalmology Director of Cornea and Refractive Surgery Rush University Medical Center Financial Disclosure Alcon Consultant Allergan Consultant Bausch and Lomb Consultant Introduction The goal of cataract surgery in the year 2012 is to achieve emmetropia or balance with the fellow eye. 1. The spherical component is calculated using IOL Master or LensStar Water bath ultrasound Keratometery or topography 2. The astigmatic component can be controlled by Size and location of the cataract wound Intra-operative relaxing incisions Toric IOLs Post-operative Astigmatic Keratotomy, Wound Revision or Excimer laser Introduction Control of Astigmatism is especially important with the use of accommodating and pseudo-accommodating IOLs and phakic IOLs Goal is to achieve < 0.50 D of post-op cylinder What is the best way to manage astigmatism? PCRI Toric IOLs Peripheral Corneal Relaxing Incisions (PCRI) Incisions made ~ 90% depth, in front of the limbus, in the steep meridian of the cornea Incisions in the peripheral clear cornea Heals faster Refractive effect stabilizes quickly Less irregular astigmatism, glare and foreign body sensation Pre-operativeAssessment of Astigmatism Magnitude and Axis • Manual Keratometry • IOL master or LENSTAR • Corneal Topography • Elevation mapping Pre-operativeAssessment of Astigmatism • Best test for axis • IOL master – quantitative • Topography – qualitative • Best test for power • Manual Keratometry Peripheral Corneal Relaxing Incisions - Technique Alignment is critical! Mark the 6 o’clock position on the patient’s limbus with the patient sitting up looking straight ahead with both eyes open III. Peripheral Corneal Relaxing Incisions - Technique Mark the steep corneal axis, in the OR, using a marked fixation ring, astigmatic ruler or arcuate marker with the 90º mark aligned with 6 o’clock III.
    [Show full text]