Eyes Wide Open

Specialists handle multiple conditions at South Tampa clinic.

In September, Pauline Thai,  OD, Dr. Thai is an optometrist specializing in primary care and ocular disease.celebrated two years with Florida Eye Specialists & Cataract Institute. Dr. Thai is an optometrist specializing in primary care and ocular disease at the institute’s South Tampa Eye Clinic.

“I provide comprehensive eye care for patients ages 10 and older,” Dr. Thai expounds. “I see a variety of patients, from those who present with acute issues, such as eye infections or foreign bodies in their eyes, to those who need their yearly routine care. I also follow patients with chronic eye conditions, such as macular degeneration and glaucoma, to manage their ongoing eye health.”

There are two types of macular degeneration: dry and wet. Dr. Thai typically follows patients with dry macular degeneration on a six-month to yearly basis, depending on the severity of the signs and symptoms. The most common symptom is blurred or distorted central vision. 

“Macular degeneration is usually age-related, so it’s called age-related macular degeneration, or ARMD,” Dr. Thai informs. “There is also a genetic association to the disease as it tends to run in families, and there are environmental factors as well, including smoking.”

Dry ARMD involves degenerative changes to the macula, which is the center portion of the retina. The macula controls a person’s central, detailed vision.

“Typically, I recommend that patients with signs of dry ARMD begin taking specially formulated vitamins, such as Ocuvite® or PreserVision®,” Dr. Thai says. “These vitamin formulations have been shown in clinical studies to help reduce the risk of progression to advanced macular degeneration. A healthy, balanced diet as well as UV protection are other important factors that can help lower the risk of progression as well.”

Dr. Thai also asks ARMD patients to monitor their vision for changes using an Amsler grid, a chart composed of horizontal and vertical lines. If someone looks at the grid and the lines appear wavy or distorted, or if sections are missing, it may indicate changes in the central vision and progression of the disease. 

“During regular patient visits to the clinic, we perform fully dilated eye exams, which enable us to evaluate and monitor the retina and macula,” Dr. Thai relates. “We also use an imaging technique called optical coherence tomography, or OCT, which scans the layers of the macula and allows us to visualize any changes due to macular degeneration.”

Among the changes Dr. Thai looks for are small yellowish deposits of cellular debris called drusen that accumulate under the retina.

“The presence of drusen is a classic sign of dry ARMD,” Dr. Thai maintains. “But drusen can also be present in the wet form, which is the more severe type of macular degeneration. With wet ARMD, there’s swelling and leaking of fluid in the macula from incompetent blood vessels that form within the retina.

“As a rule, I don’t treat patients with wet ARMD. They are usually followed by a retina specialist. Wet ARMD is generally treated with medication injections that can help slow down its progression and resolve the leaking from the abnormal blood vessels.”

Diabetic Retinopathy

When patients at the South Tampa Eye Clinic develop wet ARMD, Dr. Thai usually refers them to Evan N. Dunn, MD, a fellowship-trained retina specialist. Dr. Dunn treats adults with other disorders of the retina as well, including diabetic retinopathy, a leading cause of treatable vision loss.

Diabetic retinopathy is the most common cause of vision loss in working-age adults. High blood sugar causes abnormalities in the retinal blood vessels that may slowly decrease the quality of vision or cause sudden vision loss.

“The vast majority of patients who follow up as recommended can avoid losing vision from diabetic retinopathy,” Dr. Dunn stresses. “We are very fortunate that advances in technology have allowed us to maintain and improve vision in working-age adults who suffer with diabetes.”

There are two main types of diabetic retinopathy: nonproliferative and proliferative.

“The nonproliferative type is an early stage of diabetic retinopathy characterized by small outpouchings of normal blood vessels called microaneurysms and tiny areas of bleeding within the retina,” Dr. Dunn explains. “These retinal changes may progress to a much more serious type of diabetic retinopathy that, if left untreated, may cause permanent vision loss.

“We monitor these patients routinely to make sure that if worsening occurs we can treat it before the patient ever loses vision.”

The most severe form is proliferative diabetic retinopathy. People with this condition have a 50 percent chance of losing their vision, but significant advances allow retina specialists to restore vision and prevent vision loss in most cases, Dr. Dunn relates.

“Some patients may develop leaky blood vessels that decrease vision, a condition called macular edema,” Dr. Dunn informs. “There are a number of well-established and new treatments available to restore vision in patients who develop this condition.”

Cataract Surgery

According to the American Academy of Ophthalmology, more than 24.4 million Americans ages 40 and older are affected by cataracts, which are a clouding of the normally clear eye lens. 

“Cataracts are a natural part of the aging process that typically begins in the late 50s and progresses from there,” explains Dilip “Dr. Samy” Rathinasamy, MD, a board-certified ophthalmologist and cataract surgeon at Florida Eye Specialists & Cataract Institute’s South Tampa location. “With cataracts, the eye’s lens that used to be crystal clear naturally turns hazy over time.

“A hazy lens can cause decreased vision during the day and at night, and increased glare and halos while driving at night. It can also cause difficulty with activities such as reading and watching television. There’s no treatment other than surgically removing the cloudy lens and replacing it with an artificial intraocular lens, or IOL.”

There are many types of IOLs. The standard IOL is a monofocal lens. This lens gives patients good vision in one focal point, such as distance. 

“Monofocal IOLs do not treat astigmatism, which is an irregular curvature in the lens or cornea that leads to distorted, fuzzy or blurry vision,” Dr. Samy states. “There are special lenses, called toric lenses, that treat astigmatism only. And there are multifocal lenses that can do both.”

Multifocal lenses correct for all ranges of vision — near, distance and intermediate — and can reduce or eliminate the need for glasses following cataract surgery. The main drawback to multifocal lenses is they sometimes produce visual disturbances, such as rings and halos around lights at night.

Last year, a new type of multifocal lens came on the market, the Alcon AcrySof® IQ Vivity® lens.

“The Vivity is a new generation of multifocal lens that we refer to as an extended depth-of-focus lens,” Dr. Samy explains. “It uses innovative technology that bends light rays entering the eye, allowing light to focus properly on the retina. The retina converts light rays into electrical signals and sends those signals to the brain, which interprets them as images.

“The Vivity technology corrects blurriness and gives patients clear distance, near and intermediate vision, and often eliminates the need for glasses completely. The biggest advantage of the Vivity lens is that it has a significantly lower risk of nighttime visual side effects compared to other multifocal technologies.”

Eyelids and Appearances

The look of the eyes and face says a lot about a person, which is why it’s essential that people take special care of these areas. When age, genetics or sun exposure affect the eyes and face, fellowship-trained oculoplastic surgeon Robert J. Applebaum, MD, MBA, goes to work at the South Tampa Eye Clinic. 

Dr. Applebaum uses his skills to perform a variety of cosmetic and functional procedures on the face and eyes, including blepharoplasty.

“Blepharoplasty is a surgical procedure that involves removing excess eyelid tissue, which can make people look tired, sad or even mean upon first impression,” Dr. Applebaum describes. “Blepharoplasty can be done on both the upper and lower eyelids, and it can make a dramatic difference in the appearance of the face.

“During upper blepharoplasty, excess skin is removed from the upper eyelids, which can droop due to muscle weakness. The repairs I perform help functionally because the excess tissue can get in the way of vision and endanger the patient. It can also cause headaches and other problems.

“I also perform blepharoplasties for cosmetic purposes, such as when people are unhappy with the appearance of their lids. These surgeries can significantly improve the look of their eyes.”

The lower lids can project a poor first impression as well, Dr Applebaum relates.

“Most people are born with five bags of fat around the eye to protect it and hold it in the socket,” the doctor educates. “However, with aging, that fat can come forward and appear as puffiness under the eye. Lower blepharoplasty can diminish the look of tiredness and aging by decreasing excess fat and skin beneath the eyes.”

Dr. Applebaum performs other surgical procedures as well, including reconstructions following skin cancer removal, endoscopic eyebrow and forehead lifts, tear duct surgery, earlobe reconstructions and correction of eyelid malposition.

Children’s Eye Care

G.S. “Jack” Guggino, MD, and Michael A. Lopez, MD, are pediatric ophthalmologists at the South Tampa Eye Clinic. They treat newborns, infants, toddlers, preteens and teenagers.

“We recommend that children have their first routine eye exam during the first year of life,” Dr. Guggino states. “Many ocular conditions show no signs of being present and can be successfully addressed when diagnosed early. Follow-up eye exams should then take place at two-year intervals.”

Common conditions in childhood and adolescence are myopia (nearsightedness), hyperopia (farsightedness) and astigmatism. These are refractive errors – vision problems caused by the eye’s inability to properly focus light on the retina to form clear images.

“Children who are farsighted can clearly see objects in the distance but have difficulty seeing objects up close,” Dr. Lopez describes. “Those who are nearsighted have the opposite problem; nearby objects are clearly visible but faraway objects are out of focus. Nearsightedness, farsightedness and even astigmatism can easily be corrected with prescription eyeglasses.”

Dr. Guggino and Dr. Lopez treat other routine conditions, including infections, blocked tear ducts, styes, chronic tearing and any problem caused by foreign bodies children may get in their eyes. Two of the more common disorders they treat are amblyopia and strabismus.

“Amblyopia, or lazy eye, occurs prior to the age of 9 years when one eye is deprived for any reason of clarity of vision,” Dr. Guggino explains. “This could be due to uneven astigmatism or farsightedness. It can be caused by a deviating or misaligned eye (strabismus) or a cataract. 

“Amblyopia is typically treated by providing the best vision possible in the problem eye and patching the other eye.” 

With strabismus, the eyes cross toward each other (esotropia) or deviate away from each other (exotropia). Strabismus is treated with glasses, surgery or both.

Dr. Guggino and Dr. Lopez understand that children may be frightened when visiting an eye doctor for an examination. To ease fears, these physicians and their staff create a calming environment where children can feel secure and unthreatened. 

“When I see patients at the South Tampa clinic, the office is transformed into a child-friendly oasis,” Dr. Lopez describes. “The environment and the personnel are all dedicated to the needs of children. In the waiting area, there are children’s videos playing and there is a playroom for the children to enjoy.”

Corneal Transplants

Priya M. Mathews, MD, MPH, is a fellowship-trained cornea specialist at the South Tampa location. Her primary interest is the treatment of conditions affecting the cornea. She performs a range of corrective eye procedures, including cornea surgery, refractive surgery and cataract surgery.

“The field of corneal transplantation has significantly advanced over the past few years.  One of my favorite surgeries to perform is DMEK (Descemet membrane endothelial keratoplasty), which is a newer, more advanced type of corneal transplant.”

The cornea is made up of five layers, and during a traditional cornea transplant, the entire cornea is removed and replaced with donor tissue. With the newer surgical techniques, including DMEK, surgeons can select the diseased layer of the cornea and replace only that layer.

During DMEK, the surgeon removes and replaces two very thin layers of the cornea, the Descemet membrane, which lies deep in the cornea, and the endothelium.

“Techniques such as DMEK, which transplant only a portion of the cornea, provide patients with much better vision than can be achieved by replacing the entire cornea,” Dr. Mathews asserts. “And because the patient is keeping most of their own cornea and only receiving a small piece of donor tissue, there is less chance for rejection.”

Dr. Mathews also performs keratoprosthesis, which is the replacement of the entire cornea with an artificial cornea. This may be an option for patients who are not suitable candidates for fresh tissue transplant.

“Corneal transplants are the most frequently performed transplants in the world, so advances such as DMEK and artificial corneas are really exciting,” she states.

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. mkb


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