Understanding How Vision Changes

Many things change as time passes. Vision is one of them. The aging process affects clarity and quality of vision, which may affect your ability to drive at night. Two primary causes of vision loss with age are cataracts and presbyopia.

Cataracts affect most people over the age of 65 and some younger people as well. This condition occurs as the natural lens inside the eye becomes cloudy. This clouding scatters the light passing through the eye, resulting in hazy and blurred vision.

Presbyopia – the loss of near reading vision is a condition that affects everyone over the age of 45. Presbyopia occurs when the natural lens of the eye becomes firmer and less flexible. This reduces the eye’s ability to switch from seeing objects at a distance (for driving) to seeing objects that are near (for reading.)

Advances in Cataract Surgery - With approximately three million procedures performed each year in the U.S., cataract surgery is the most common surgical eye procedure. It has a proven track record for restoring vision. The standard surgical treatment for cataracts is to remove the cloudy crystalline lens (cataract) and replace it with an intraocular lens implant to restore vision. When performed using a conventional lens implant, this treatment still leaves many people dependant on glasses in their daily lives. Now new lens technologies allow us to do more. Today, presbyopia can be treated at the same time as cataracts with new technology lens implants.

The Opportunity to Reduce Your Dependence on Glasses in Everyday Life. Today, you have lens implant options that can provide the vision to do everyday tasks without depending on glasses.

For those people that don’t mind wearing glasses or those who have certain eye health issues, a conventional lens implant (“monofocal” lens) may be the best option. Implants such as these have been used to treat millions of people, and provide good vision after cataract surgery. Your doctor will explain these options if they are right for you.

At The Rhode Island Eye Institute, we have six experienced doctors who specialize in cataract surgery.

Call our office in Providence at 401-272-2020, our East Providence office at 401-437-0500, our South Kingstown office at 401-272-2020, or our Fall River office at 508-679-0150 to schedule an appointment with Robert Bahr, M.D., Thomas Lang, M.D.,, Elliot M. Perlman, M.D., Christopher J. Newton, M.D.,  Sarah Anis, M.D., and Durga S Larkin, M.D..

Robert Bahr, M.D.	Thomas Lang, M.D.
Elliot M. Perlman, M.D.	Christopher J. Newton, M.D.
Sarah Anis, M.D.	Durga S Larkin, M.D.

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We provided general eye exams, contact lenses fittings and low vision services

The contact lens service at The Rhode Island Eye Institute includes a comprehensive eye exam, contact lens fitting and instructions.

There are many types of contact lenses and our experienced optometrists will provide the correct contact lenses and fit to meet your needs.

Lori Boivin, O.D. (Providence)	Martin Newman, O.D. (Providence)
Michael A. Saccucci, O.D. (South Kingstown)	Paul Zerbinopoulos, O.D. (South Kingstown)

At The Rhode Island Eye Institute, our optometrists, Lori Boivin, O.D., Martin Newman, O.D., Michael A. Saccucci, O.D., and Paul Zerbinopoulos, O.D. provide comprehensive eye exams, contact lenses fittings and low vision services.

Call our office in Providence at 401-272-2020, our South Kingstown office at 401-272-2020, or our Fall River office at 508-679-0150 to schedule an appointment.

Some corneal diseases are easily treatable with new glasses or simply with drops

The cornea is the clear transparent dome in the front of the eye. In addition to allowing light to pass through the eye, the cornea does most of the bending (refracting) of light so that it can focus clearly on the retina.

Corneal edema (swelling), corneal dystrophies (inherited diseases), corneal scars, injuries, and infections can cause a normal, clear cornea to become cloudy, resulting in loss of vision in one or both eyes.

Some diseases such as keratoconus distort the shape of the cornea, so that the incoming light is not clearly focused on the retina. Even though the cornea appears clear in these diseases, the patient’s vision can still be very blurry.

Examination - A technician evaluates your visual acuity and checks your glasses prescription. Then the doctor examines the front part of the eye using a slit lamp bio-microscope, an instrument that provides a magnified view of the cornea.

In some cases other tests may be required. These include pachymetry, which measures the thickness of the cornea, or corneal topography, which creates a computerized contour map of the cornea.

Treatment - Some corneal diseases are easily treatable with new glasses or simply with drops. Many cases of keratoconus can be treated with contact lenses.

More severe corneal scars, advanced dystrophies, and advanced keratoconus are often treated with corneal transplant surgery.

Corneal Transplantation is a delicate but highly successful procedure. Under an operating microscope, the doctor removes the diseased part of the cornea and replaces it with a donated healthy cornea. The donor cornea is secured into position with a number of very fine nylon sutures. The operation, which takes about an hour, is most often performed as an outpatient procedure and done with either local or general anesthesia.

What is Corneal Crosslinking (CXL)? - Until 2003, there was no treatment to stop or reverse the progression of the disease. In that year, Dr. Theo Seiler and other ophthalmologists in Germany found that putting riboflavin drops on the corneas of keratoconus patients and then treating the corneas with a specific wavelength of ultraviolet (UV) light would strengthen the cornea, and halt the progression of the disease in most patients. The UV light induces a chemical reaction which links fine fibrils in the cornea together. The successful results of this treatment have been verified in numerous excellent clinical studies throughout the world. CXL has thus become the standard of care for keratoconus patients everywhere else in the world (except for the US). Dr. Perlman is the first Rhode Island ophthalmologist to offer the only FDA-approved corneal cross-linking therapy for the treatment of progressive keratoconus and corneal ectasia.

Elliot M. Perlman, M.D. is one of the first corneal surgeons in New England to perform a new type of corneal transplant, called DSAEK (Descemet's Stripping Automated Endothelial Keratoplasty). In this procedure, only the innermost layers of the cornea are transplanted. DSAEK utilizes very few sutures and allows a more rapid recovery time than conventional corneal transplant.

Christopher J. Newton, M.D. is a leading regional corneal surgeon, specializing in the surgical and medical treatment of corneal and anterior segment disease including keratoconus, Fuch's dystrophy, corneal ulcerations, ocular surface disorders and dry eye.

Call our office in Providence at 401-272-2020, our East Providence office at 401-437-0500, our South Kingstown office at 401-272-2020, or our Fall River office at 508-679-0150 to schedule an appointment.

The Boston Keratoprosthesis (“K PRO”)

Many people with corneal disease can be helped by regular corneal transplantation using tissue transplanted from human donors. However, in some cases such transplantation is hopeless, or nearly so. In these situations, a small number of institutions in this country and elsewhere have resorted to the implantation of a keratoprosthesis of plastic material which serves as an artificial cornea. In effect, the prosthesis provides a clear window in the clouded cornea. Although this idea is obvious and has been tried for a long time, it has taken much research and clinical trials to develop prostheses that can tolerated by the eye over a long period of time.

The keratoprosthesis that was designed by Claes Dolhman, MD, PhD, at the Massachusetts Eye and Ear Infirmary, is made of medical grade polymethylmethacrylate—the same material that is used in contact lenses and in intraocular lenses after cataract surgery. The device is shaped like a collar button and it is inserted into a corneal graft. This graft-prosthesis combination will then replace the patient’s cloudy cornea. If the natural lens is in place, it is also removed. Finally, a soft contact lens is applied.

Most candidates for keratoprosthesis have little eye inflammation (after corneal edema, trauma, infection, transplant failures, etc.), and prognosis for a keratoprosthesis is very good. The majority of such patients do very well for a long time and the vision as a rule becomes much improved. Infections are very rare as long as prophylactic antibiotic drops are instilled on a regular basis, usually once or twice daily, for life.

Eyes needing a keratoprosthesis often have glaucoma, requiring standard anti-glaucoma mediation, occasionally even surgical implantation of a valve shunt.

Patients with keratoprosthesis require regular ophthalmological examination. It is customary to return every month for a check-up during the first half year. Subsequently, the intervals can be longer. Medication, usually as drops, will have to be taken for life. Also, soft contact lens wear around the clock (no discomfort) is recommended for safety.

Since 1990, several thousand of these keratoprostheses have been implanted worldwide. More than half of these patients have achieved marked and long-term improvement of vision.

Cosmetic Treatments

The Rhode Island Eye Institute offers a full range of surgical and non-surgical cosmetic procedures that can dramatically improve the appearance of the eyes, forehead, face and neck.  Ophthalmic plastic and reconstructive surgeons – such as our own Dr. R. Jeffrey Hofmann - are trained and certified in both eye surgery and plastic surgery making them the best qualified to perform delicate and complex procedures. “Puffiness”, “bags”, and “circles” around the eyes, drooping brows, as well as fine lines, wrinkles, jowls, scars in the skin, and many other manifestations of the aging process can now be treated often with minimal or no downtime.

The latest advances in cosmetic facial procedures and skin rejuvenation make it easier than ever to maintain a healthy, youthful appearance. Some of these procedures such as Botox®, and facial fillers - including Restylane, Collagen and Juvederm - are non-invasive, requiring no downtime at all.  Others, such as blepharoplasty (eyelid tuck), fat injections, or liposuction require minimal downtime.

When considering cosmetic surgery, especially of the eyes and surrounding face, it is wise to consult a certified ophthalmic plastic surgeon (see www.asoprs.org), an ophthalmologist, who specializes in the sensitive tissues around the eyes.  There are less than 500 of these specially trained physicians in the country.

At The Rhode Island Eye Institute, R. Jeffrey Hofmann, M.D. is our expert in cosmetic treatments and surgery. Call our office in Providence at 401-272-2020, our East Providence office at 401-437-0500, or our Fall River office at 508-679-0150 to schedule an appointment with Dr. Hofmann for a consultation or to discuss any of the following procedures.

• Botox®  – a simple in-office non-surgical procedure to smooth lines by relaxing the muscles which cause them.
• Facial Fillers (including Restylane and Juvederm) – non-surgical injectable products used to fill in or eliminate wrinkles and folds.                      
• Blepharoplasty (eyelid correction) – is a small-incision surgical procedure to correct excessive skin and fat pockets of the upper and lower eyelids.
• Eyebrow and Forehead lifts  – are surgical procedures designed to reposition and contour the eyebrows and help smooth the forehead.
• Laser Skin Resurfacing  - a procedure that uses a precise laser to smooth facial wrinkles, acne scars, and other common signs of aging and sun-damage.
• Fat transfer (“liposculpture” or “fat injections”) – a procedure in which fat is taken from another area of the body and carefully placed in the face to create more youthful contours.
• Midface lift – a procedure done with small incisions around the eyes to lift the cheek fat pads and smooth the contour of the lower eyelid and cheek.

Glaucoma

Glaucoma is a disease of the optic nerve, which carries the images we see from the eye to the brain. Glaucoma occurs when there is slow damage to the optic nerve due to increased pressure in the eye. This pressure is usually caused by poor drainage of the aqueous fluid out of the eye.

The most common form of glaucoma is called “primary open-angle glaucoma.” This condition is painless and the patient can slowly lose vision and not be aware of the problem until it is very advanced. Glaucoma is a leading cause of blindness in the United States, especially for older people. If untreated, glaucoma can lead to total loss of vision, which is why early detection through routine eye exams and treatment are so important.

Examination

During your glaucoma examination, your doctor will:

• Measure intraocular pressure (tonometry)
• Inspect the drainage angle of the eye (gonioscopy)
• Evaluate any optic nerve damage (ophthalmoscopy)
• Test the peripheral vision of each eye (visual field testing, or perimetry)
• Take color stereoscopic photographs of the optic nerves which are used to follow the appearance of the optic nerve

Additional Testing

At The Rhode Island Eye Institute, we are proud to have the latest state-of-the-art technologies to help diagnose and manage glaucoma, including:

• FDT (Frequency Doubling Technology). This is a sensitive screening test to see if any glaucoma damage is present. It tests the health of the specific retinal cells that can be damaged in very early glaucoma.
• OCT (Optical Coherence Tomography). This remarkable device uses ordinary light to create a CAT-scan-like cross-section of the optic nerve and nerve fiber layers to detect damage from glaucoma.

At The Rhode Island Eye Institute, Robert L. Bahr. M.D. and Sarah Anis, M.D. specialize in the diagnosis and treatment of glaucoma.

Call our office in Providence at 401-272-2020, our East Providence office at 401-437-0500, our South Kingstown office at 401-272-2020, or our Fall River office at 508-679-0150 to schedule an appointment.

Robert Bahr, M.D.	Sarah Anis, M.D.

Optical Department

For your convenience, we have an optical department in our Providence and South Kingstown locations.

We offer a large selection of designer and traditional eyewear for adults and children.  We have the latest styles and the hottest brands.  We also carry sunglasses, sports goggles and many other fashion, optical accessories.  Our knowledgeable and friendly staff can help you choose from our complete lens menu and our full line of designer frames to fit your lifestyle and fill your prescription.  Our goal is to make this your one-stop shop for all your eyewear needs.

Come in and see us or call our optical boutique in Providence at 401- 454-3422 or South Kingstown at 401-360-3023 for more information.

Hours of Operation

Monday - Thursday – 8:00 am to 6:00 pm
Friday – 8:00 am to 5:00 pm

 

Optical Staff in Providence	Optical Department in South Kingstown

Pediatric Ophthalmology

Pediatric ophthalmology is a subspecialty of ophthalmology that deals with diseases and conditions of the eye in infants and children. These conditions include: congenital glaucoma, congenital cataracts, infections, strabismus (wandering eye), amblyopia (lazy eye), and ptosis (drooping of the upper eyelid). When left untreated, these conditions can become quite serious, but with early detection and treatment, vision can be corrected and preserved.

Examination

It is recommended that all children have their vision checked by their pediatrician, family doctor, or ophthalmologist before their fourth birthday. If any problem is detected, the child should be referred to a pediatric ophthalmologist for a more specialized eye exam. Most serious eye problems that affect children can be diagnosed during an eye examination by a pediatric ophthalmologist.

Treatments

Depending on the diagnosis, the pediatric ophthalmologist may recommend the following treatments:

• Congenital glaucoma and congenital cataracts may both be treated surgically.
• Most eye infections are cleared up with antibiotic drops, although occasionally serious infections around the eye require an oral medication.
• Strabismus is a condition in which the eyes are not perfectly aligned. A child with strabismus can be “cross-eyed” (esotropic) or “wall-eyed” (exotropic). Some types of strabismus may be improved through the use of corrective lenses; other types may require surgery to reposition the muscles that move the eyes.
• To correct amblyopia (lazy eye), a patch is placed over the strong eye to help strengthen the weak eye. Occasionally eye drops are used to blur the vision of the strong eye to cause the child to use the weak eye. Glasses may be prescribed to correct errors in focusing.
• Ptosis, or drooping eyelids, in both children and adults can be treated with surgery to improve vision as well as appearance.

John Donahue, MD, Ph.D., specializes in pediatric ophthalmology. Dr. Donahue also treats cases of adult strabismus. Call us at 401-272-2020 in our Providence office for more information or to schedule an appointment.

Reconstructive Surgery

Eye reconstructive surgery is a specialized area of ophthalmology that focuses on the eyelids and the structures surrounding the eye, including problems of the lacrimal (tear) system and the orbit, the region surrounding the eyeball. Ophthalmic Plastic and Reconstructive surgeons – such as Dr. R. Jeffrey Hofmann – are the most qualified physicians to treat these conditions. They have had extensive training in surgery of the eye and even more training in reconstructive surgery with particular attention to the eyelids and face.  Dr. Hofmann has been a fellow of the American Society of Ophthalmic Plastic and Reconstructive Surgery for over twenty years (see www.asoprs.org).

Most reconstructive procedures are performed to improve the function of the eye following trauma, removal of a tumor, or eyelid malposition.  But care is taken to improve aesthetic appearance as well.

Examination and Treatment

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Jeffrey Hofmann, M.D.,

Jeffrey Hofmann, M.D., specializes in plastic and reconstructive surgery at The Rhode Island Eye Institute.

Call our office in Providence at 401-272-2020, our East Providence office at 401-437-0500, or our Fall River office at 508-679-0150 to schedule an appointment.

Refractive Surgery / LASIK

Refraction refers to the bending of light as it passes through the cornea and the lens to the retina. Three factors can play a part in determining how well the eye refracts (or bends) light: the shape of the cornea, the power of the lens, and the length of the eyeball.

When these three factors are in correct proportion to one another, light is properly focused on the retina resulting in clear, normal vision. However, if any of these factors are not in correct proportion, refractive problems such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism can occur.

The conventional treatment for these conditions is glasses or contact lenses. However, more and more people are now choosing refractive surgery, or LASIK (laser in-situ keratomileusis), to correct their vision. A highly successful procedure, LASIK can significantly reduce or eliminate the need for corrective lenses.

Examination

The Rhode Island Eye Institute offers free screening to determine if you are a candidate for LASIK. The ideal candidate is over 18 years of age and has healthy corneas. Candidates must not have had a significant increase in their prescription in the last 12 months. People with certain medical conditions or women who are pregnant may not be good candidates for LASIK.

Treatment

The LASIK procedure uses the Excimer laser to surgically reshape the cornea, the clear dome in the front of the eye. First the eye is completely numbed with anesthetic eye drops and an eyelid holder is placed between the eyelids to prevent blinking. The doctor uses an instrument called a microkeratome to create a protective flap in the front of the cornea. The flap is then retracted and a small amount of corneal tissue is removed with the laser.

Some patients may be candidates for a new kind of LASIK called CustomVue™ or “wavefront”. This enhanced version uses WaveScan®-based digital technology to create a precise, customized 3-D map of the eye called a WavePrint®.

The WaveScan consists of a sensor and a laser, which sends a wave of light through the eye to the retina. As the light is reflected back through the eye, the sensor measures the unique characteristics of the eye. This information is then translated into a mathematical formula that the doctor uses to program the laser and perform the procedure.

PAYMENT OPTIONS

Our staff will explain your financial responsibilities in detail.

Payment in Full

Payment in full is accepted via cash, check or credit card before treatment.  For your convenience, we accept major forms of credit card.

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Retinal Diseases

The retina is a very thin, but complex tissue that lines the back of the eye. It is composed of millions of cells, including photoreceptor cells that sense light and send images to the brain.

There are many conditions that can impair the retina’s ability to receive and transmit images. The most common retinal diseases are diabetic retinopathy, age-related macular degeneration, and retinal detachments. These conditions are all very serious and if not treated, can lead to loss of vision.

Examination

A retinal examination is the only way to properly diagnose retinal problems. Serious retinal diseases can often be treated before the patient begins to experience vision problems. During the exam the ophthalmologist first dilates the pupil using drops and then looks inside the eye with an ophthalmoscope, a device that allows the physician to clearly see the retina.

In some cases, additional testing is required. One test is a fluorescein angiogram, which can help the doctor evaluate the retina more easily. In this test, a small amount of dye is injected into a vein in the hand or arm. As the dye circulates through the blood vessels of the retina, photographs of the retina are taken.

Another effective test is the Optical Coherence Tomography (OCT), a new technology we are pleased to offer at The Rhode Island Eye Institute. This rapid imaging device bounces light rays off the retina and the reflections are transmitted to a computer. The result is a detailed 3-D cross-section of the retina.

Treatment of Retinal Diseases

Many retinal diseases can be treated with various forms of laser light. These very powerful light beams can help destroy abnormal blood vessels in the retina or act to seal off retinal tears. Laser therapy is usually done in our office with anesthetic drops or anesthetic injection around the eye to ease any discomfort.

Other retinal diseases require surgery. Most retinal surgery involves first removing the vitreous gel (the clear fluid inside the eye), and then using delicate instruments to remove any abnormal tissue from the surface of the retina. Retinal surgery is usually done in a hospital operating room with a local anesthetic.

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Lory Snady-McCoy, M.D. and Gaurav Gupta, M.D. treats all medical and surgical diseases of the retina and vitreous. Call 401-272-2020 in our Providence office or call 508-679-0150 our Fall River office for more information or to schedule an appointment.

Lory Snady-McCoy, M.D	Gaurav Gupta, M.D.

Call our office in Providence at 401-272-2020, our East Providence office at 401-437-0500, our South Kingstown office at 401-272-2020, or our Fall River office at 508-679-0150 to schedule an appointment.

Comprehensive Eye Exams

Comprehensive eye exams are essential to maintaining good eye health. In addition to correcting vision problems, a routine exam can detect many eye diseases, such as glaucoma, before any symptoms are present. Early detection is key to treating such diseases and preventing any vision loss.

Many people get eye exams because they are experiencing difficulty with their vision. The most common vision problems include myopia (nearsightedness), hyperopia (farsightedness), astigmatism, and presbyopia. Myopia affects about 25% of the population and results in the ability to see clearly up-close, but not at a distance. Hyperopia has the opposite effect, affecting the ability to clearly see near objects. Astigmatism is an irregular curvature of the cornea that makes it difficult for the eye to focus clearly at any distance. This condition can occur in conjunction with nearsightedness or farsightedness.

Presbyopia affects older people due to the natural loss of flexibility of the lens as we age. Individuals with this condition can no longer focus up-close and need glasses for activities such as reading or using the computer.

Examination

At your eye exam, the doctor will assess the overall health and function of your eyes. The sharpness of your vision will be checked with visual acuity tests. A pressure test checks for glaucoma. The doctor may dilate your eyes using drops to get a better view of the internal structures of your eye. If you have been dilated, you should not expose your eyes to bright light for a few hours after the exam until the effects of the drops wear off.

Frequency of Eye Exams

If you are under 40 and have no known eye conditions or diseases, you should have your eyes checked about every two years; if you are over 40, every year is strongly recommended.

Treatment

If any other conditions are detected during the exam, the doctor will recommend the appropriate treatment or refer you to a specialist.

Joseph Dowling, Jr., M.D.	Dugald H. Munro, M.D.
Michael A. Saccucci, O.D.	Paul Zerbinopoulos, O.D.