Florida Eye Specialists & Cataract Institute: Your Family’s Eye Care Destination

The origin of the phrase “The eyes are the windows to the soul” is uncertain. The saying has been attributed to several sources, including William Shakespeare, Marcus Tullius Cicero, even the Bible. But no matter who said it first, the phrase accurately describes the eyes as precious portals into an individual’s character. The highly trained physicians and staff at Florida Eye Specialists & Cataract Institute’s South Tampa Eye Clinic are devoted to providing premier care to these “windows.” The clinic offers full-service eye care to the entire family, from newborns to seniors. Addressing children’s eye health at the South Tampa Eye Clinic is Michael A. Lopez, MD, FAAP, FACS, a pediatric ophthalmologist. Dr. Lopez treats patients from birth to age 20. Pediatric ophthalmologists primarily examine children who’ve been referred by their pediatrician or someone at school who suspects a problem with their eyesight,” Dr. Lopez informs. “Sometimes families bring their children in for evaluation because they’re concerned about visual problems they’ve noticed.” Among the common childhood eye disorders addressed by Dr. Lopez are strabismus, which is drifting or crossed eyes; blocked tear ducts in babies; and styes (chalazia) on the eyelids. Refractive errors, particularly myopia (nearsightedness), are common in older children and are generally corrected with eyeglasses. “To treat strabismus, we typically try glasses or patching therapy first to see if we can improve the drifting,” Dr. Lopez details. “If those treatments don’t work, we might try eye muscle surgery to straighten the eyes. “If a tear duct doesn’t open with medical therapy by the time the child is a year old, we’ll typically perform surgery to open it. “Chalazia in children are different than in adults. In children, styes are more of a skin condition, such as acne. With adults, a simple surgery is usually performed to remove chalazia. But with children there’s more work involved. We must first use eyelid cleansing, warm compresses and medications. If we just remove the stye and don’t do all the steps in the treatment, another stye will just grow back.” Another condition that’s different in children is cataracts, which are changes to the lens that cause it to become cloudy and distort vision. Cataracts in adults are typically removed through surgery, but the procedure for children is more complicated. “Cataract surgery in children takes hours to perform instead of just minutes, as it is with adult cataract surgery,” Dr. Lopez educates. “It’s also much higher risk, about 20 times the risk of an adult surgery. “In children, we replace the affected cloudy lens, but we also perform a procedure called vitrectomy to remove the gel-like fluid in the back of the eye. We do this posterior cleanup because children scar easily and can develop a post-cataract scar in the back of their eye that can affect vision.”

Debate by State

There is no consensus in the US about when children should first be examined by an eye care professional. “There are about seven states that require all children entering preschool or kindergarten to undergo vision testing,” Dr. Lopez reports. “Unfortunately, in those states the rate of glasses prescribed is four to five times higher compared to states that don’t have this requirement. This can be an issue because not all children with mild vision problems need glasses. Many of them can do very well without them. “Florida is not one of those states. In Florida, we recommend that children have their vision tested whenever a parent, teacher or pediatrician is worried about a possible problem. These people are tasked with regularly checking the child’s vision to be sure the child is seeing well. As a result, we don’t overprescribe glasses, and I’m good with that.” One of the conditions pediatric ophthalmologists hope to identify early is amblyopia (lazy eye.) With amblyopia, which usually develops in infancy or early childhood, there’s reduced vision in one eye. Amblyopia is most often treated by patching the stronger eye. This forces the weaker eye to work harder and get stronger. Treatment is less demanding and more effective in younger children, who must typically wear the patch for one or two hours a day. “When we catch the condition late, at the age of 13, 14 or 15, the therapy is a lot harder on the kids,” Dr. Lopez acknowledges. “They must wear the patch for six hours a day, but it can’t be during school, homework or sports. It’s difficult to fit the therapy into an older child’s schedule. It’s easier with younger children because they have less academic rigor and participation in sports.”

Adults and Eyelids

Adults often have different eye care needs than children. Some adults seek treatment for drooping eyelids, which can make people look sad, tired or even angry. At Florida Eye Specialists & Cataract Institute’s South Tampa Eye Clinic, these people are often treated by Robert J. Applebaum, MD, MBA, a fellowship-trained oculoplastic surgeon. According to Dr. Applebaum, surgery (blepharoplasty) to improve the appearance of drooping eyelids can be functional or cosmetic. “The most notable difference between functional and cosmetic eyelid surgery is the effect the upper eyelids have on the patient’s vision,” Dr. Applebaum explains. “If we can show through imaging and testing that the eyelids have descended to an extent where they are interfering with the patient’s vision, the procedure is considered functional and is typically covered by insurance as medically necessary. “If we’re performing the surgery because the eyelids are visually unappealing to a patient who wants to have the lids elevated, it is considered a cosmetic procedure. In these cases, the eyelid skin has not begun to interfere with vision to the point the insurance companies would consider the procedure medically necessary.” To check for vision deficits from drooping eyelids, Dr. Applebaum performs a visual field test, which involves looking into a device at flashes of light. The doctor counts the number of flashes that can be seen with the eyes in a relaxed state. He then tapes up the eyelids, which mimics the surgery outcome, and again counts the number of flashes that can be visualized. “We also measure the height of the eyelid relative to the center of the pupil and take photographs of the eyelids that we send to the insurance company,” Dr. Applebaum details. “For Medicare to cover the procedure, the patient must show either a 12-degree or a 30 percent loss of vision due to drooping eyelids. The rule may be different for some commercial insurance providers. “To get a sense of whether you are losing vision due to heavy eyelids, people should first look for their eyelids appearing to hang over the eyelashes. If they’re constantly lifting their eyebrows to see better, that’s a good indication that the eyelids are interfering with vision.”

Surgical Solutions

The drooping of eyelid skin is called dermatochalasis, while the fall of the eyelid to a point where it affects vision is called ptosis. During a blepharoplasty, excess skin, muscle and sometimes fat is removed from the eyelid. The surgery to remove eyelid skin is pretty straightforward, Dr. Applebaum observes. “First, we carefully measure the amount of skin to be removed and mark it, so we don’t take too much or too little,” the doctor describes. “The eyelid is then numbed using a local anesthetic, and the excess skin is excised along the lines we’ve marked on the eyelid. “The skin is carefully removed, bleeding is controlled and the wound is closed with a stitch. The wound and stitch are hidden in the eyelid skinfold, so when it heals it’s very hard to see any scar. The eyelids tend to heal well, so it’s difficult to see that an incision was made.” For the first few days following surgery, which takes 20 to 30 minutes to complete, patients are instructed to use ice on the eyes to minimize swelling and place ointment on the stitches. They are also told to avoid vigorous activity for two weeks. Patients return to the office seven to 10 days later to have the stitches removed. The procedure is not particularly painful, according to Dr. Applebaum, who says that over-the-counter acetaminophen can usually erase any discomfort the patient might experience. “The most important thing for patients to understand is that whether their eyelid surgery is functional or cosmetic, the same technique is used,” the doctor notes. “Patients will receive the same high quality cosmetic outcome either way. ” Surgery for ptosis aims to lift the eyelid. It differs from blepharoplasty in that the eyelid muscle must be tightened. “We make an incision in the eyelid crease, similar to that for blepharoplasty, but there’s no skin removal with ptosis surgery,” Dr. Applebaum educates. “We determine which muscle is loose and then tighten it with a stitch.”