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Keratoconus is a progressive disorder which causes thinning and cone-like steepening of the cornea. This characteristic steepening results in distortion, which decreases visual acuity. It can cause severe astigmatism and and increased sensitivity to glare and light. In our Princeton ophthalmology practice, we offer a number of therapies to reduce the symptoms of keratoconus and help you preserve your vision.

One of the best options for improving vision in early keratoconus is the use of speciality contact lenses. They’re available in the following varieties:

  • Soft, astigmatic contact lenses
  • Rigid, gas-permeable contact lenses
  • Scleral contact lenses

As keratoconus progresses, the individual may become intolerant to contact lenses. At this point, surgical intervention is necessary. We evaluate each patient’s individual case to create an appropriate treatment plan. Often, these include 1 of the following surgical therapies:

  • Corneal transplantation: This outpatient surgery typically takes a little over 1 hour to complete. This surgery replaces the damaged native cornea with a donated cornea to improve your vision.
  • Intacs®: Corneal implants called Intacs are placed within the cornea to reshape it and reduce the symptoms of keratoconus.
  • Corneal collagen crosslinking: Also known as CXL, this is a minimally invasive procedure that uses a combination of B2 drops and ultraviolet light to strengthen the cornea.

Keratoconus is usually first diagnosed in teenagers or people in their early 20s. The disease progression can happen rapidly or slowly and can be difficult to predict. It tends to be a familial trait, and seems to be associated with habits such as eye rubbing. Keratoconus is diagnosed during an eye exam, using instrumentation called corneal topography. This tool measures the curves of the cornea.

Once diagnosed and treated with contact lenses or surgery, most patients find their vision significantly restored. This, in turn, positively influences the quality of their lives.


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Also called a “vision test,” a refraction is given as part of a routine eye examination in our Princeton-area ophthalmology practice. This test allows your eye doctor to determine the best prescription lens for your eyeglasses and contact lenses. A value of 20/20 is considered optimum, or “perfect” vision.

When performing a refraction, your eye care professional uses an instrument called a phoropter, which resembles an oversized pair of glasses. As an individual gazes through the phoropter, the doctor flips different lenses in front of their eyes until the patient chooses the correct combination of lenses. The refraction is best known to the patient as the test during which the doctor asks, “Which is better: 1 or 2?”

The results of a refraction can determine the following visual conditions:

  • Myopia, also known as nearsightedness
  • Hyperopia, also known as farsightedness
  • Astigmatism, a condition that causes blurry vision due to the shape of the cornea
  • Presbyopia, a condition that causes blurred vision at near distances. This is due to a decrease in the ability of the natural lens to focus, and it’s often related to age.

The following conditions can frequently interfere with the refraction test’s ability to correct the patient to 20/20:

  • Macular degeneration
  • Diabetic retinopathy
  • Retinal vessel occlusion
  • Retinal detachment
  • Retinitis pigmentosa

Because Medicare and many private insurance companies consider a refraction to be a non-medical test, it is not a covered benefit. Therefore, the refraction cost or fee is charged separately and payment is typically the responsibility of the patient.


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Drooping eyelids are a common problem usually associated with aging, but can be seen in younger people, too. As an eye doctor in Hamilton, NJ, I know the effects of time and gravity are the most common cause of drooping eyelids, but it’s important to know that more sinister neurologic conditions — such as myasthenia gravis or an aneurysm — could be to blame.

In most cases involving neurological issues, drooping eyelids seem to appear overnight and may be associated with double vision and pain. In these cases, patients should be promptly evaluated and get medical or neurological treatment as soon as possible.

Far more often, the eyelids gradually sag as gravity slowly tugs on the eyelids’ skin and the muscles that lift the eyelid. An eyelid surgery specialist evaluates the structures surrounding the eyelid, particularly the eyebrow and upper eyelid skin, as part of the overall assessment. Additionally, the function of the muscles that elevate the eyelid must be determined. I pay particular attention to the status of the cornea and dry eyes, because any surgical correction of the eyelid droop may increase the dry eye symptoms.

Eyelid surgery is the only treatment for drooping eyelids. If the cause of the eyelid droop is excess skin of the upper eyelids or drooping of the eyebrows, then removing the excess skin and elevating the eyebrows can produce the desired results. If the eyelid itself is drooping, this is most often caused by the muscle that lifts the eyelid being stretched. Tightening this muscle can elevate the eyelid. Cold compresses applied after the surgery can help minimize swelling, but the eye may remain swollen and bruised for approximately 7 to 10 days following surgery.

For some, the drooping eyelids can impair vision and surgery to alleviate this condition may be covered by a patient’s health insurance policy. Part of the evaluation includes photographs and a visual field with the eyelid both at rest and elevated. Private insurance companies often evaluate the testing to determine if the surgery is covered. Medicare does not take those steps. Only an examination can determine if insurance covers the procedure.

These photos demonstrate how surgery to remove excess skin helps elevate the eyelids.

Eyelid surgery can provide an expansion of the visual field and leave the eyelids feeling more rested. If you are wondering if you might be a candidate for eyelid surgery request a consultation at Outlook Eyecare, or call us at (609) 409-2777 (Monroe Township), (609) 419-1920 (Princeton), or (609) 587-4700 (Hamilton Township).


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Here at our Princeton ophthalmology group, we’re pleased to offer a better way to treat a common visual condition. Orthokeratology, or Ortho-K, corrects an individual’s vision with the use of custom contact lenses while the patient sleeps. The contact lenses are made of a rigid, gas-permeable (hard) material. Due to their unique curvature, they can reshape the corneas overnight.

Optimum vision is usually achieved after 1 to 2 weeks of wearing the contact lenses each night. Continued wear maintains excellent vision throughout the day without the need for glasses or soft contact lenses. Studies have proven that this is a safe, nonsurgical alternative for nearsighted patients. Both children and adults can benefit from the freedom that Ortho-K offers.

The most successful Orthokeratology patients include people who:

  • Consistently get 6 to 8 hours of sleep per night
  • Have less than -5.00 sphere and less than -1.00 astigmatism power in their eyeglass prescription
  • Can commit to the prescribed schedule for wearing the lens, as well as keep checkup and maintenance appointments

Because of the specialized fitting procedure, our office uses only FDA approved Orthokeratology custom contact lenses. Our contact lens professional has undergone extensive training and experience to ensure positive results.


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Excess tearing can be a perpetual nuisance. The condition occurs when the amount of tears produced by the eye overwhelms the tear drainage mechanism. Even though tearing by itself never harms the eye, it can blur vision and produce discomfort in social situations. Our eye doctors in Hamilton, N.J. understand the problems caused by excessive tearing and can treat its causes.

The tear film — a complex solution made up of mucous, salt water and oil — is essential for the health of the eye. There must be a balance between the tears produced and the tears drained. That balance is achieved when tears leave the eye. This occurs in 1 of 3 ways:

  • Evaporation
  • Down the tear ducts
  • Flowing out onto the cheek

Does dry eye cause tearing?

In most cases, no. A better definition of tearing is needed to answer this question. When tears leave the confines of the eyelids and run down the cheek, that’s called tearing.  This is almost never caused by dry eyes. Dry eye patients feel their eyes are wet and may call it tearing but the tears do not run down the cheek. Instead, patients with dry eye have excess mucous and oil in the tear film and this causes a slime that makes the eyes feel wet. Incorrectly treating the condition can make tearing worse.

Nearly all excessive tearing patients have a structural abnormality of the tear drainage system. This illustration shows the tear drainage system’s anatomy. There is a small tear duct in both the upper and lower eyelids called the canaliculus. These come together and drain to the lacrimal sac. The lacrimal sac joins with the nasolacrimal duct that travels through a bony canal to exit in the nose. 

Incorrectly positioned eyelids block the small tear ducts from contacting the tear lake, preventing tears from draining. Excess conjunctiva (the clear film that covers the white of the eye) may cover the opening to the tear duct. The nasolacrimal duct may be narrow or blocked as it travels down the bony canal into the nose. Blockage of the nasolacrimal duct not only causes tearing but also an accumulation of discharge in the eye and puts one at risk for a serious infection known as dacryocystitis.

These structural abnormalities often require surgery to alleviate the blockage and restore normal tear outflow.  Fortunately, many of these procedures are relatively minor and can be performed in the office.  Some do require outpatient surgery.

Tearing can be extremely bothersome and interfere with clarity of vision and your ability to perform at your best. Fortunately, our ophthalmology practice serving Princeton, Hamilton Township, and Monroe Township have the tools and the expertise to diagnose and treat all causes of tearing. We recommend coming in for a consultation if you’re bothered by excessive tearing.


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So you note symptoms of decreased vision and glare. Your ophthalmologist determines cataract surgery is required to improve your visual function. What additional information do you require to make an informed decision about your cataract surgery?

As our Hamilton eye doctors can attest, cataract surgery has improved drastically over the past 3 decades. Two advancements have been the vanguard of this revolution:  small incision surgery and the refinement of the intraocular lens (IOL).

Cataracts can now be removed using incisions less than one-tenth of an inch across. Surgical microscopes, a vibrating needle to break up the lens (phacoemulsification), and foldable intraocular lenses make this miracle a daily reality. These instruments in an experienced surgeon’s hands provide rapid, painless vision recovery.

The type of intraocular lens implanted at the time of your cataract surgery will determine how often you will require glasses to perform your daily tasks. The greater your understanding of these choices, the more productive your preoperative discussion with our Princeton-area ophthalmologists will be. The choice of lens implant will determine how frequently and under what circumstances you will require glasses following your surgery.

The lens in the eye sits behind the iris (i.e., the colored part) and along with the cornea, it is responsible for focusing the light on the retina.

Current IOLs are miracles of modern science; however, even the most advanced lens does not match the phenomenal capabilities of the natural crystalline lens that you were born with. Your native lens, in its youth, could effortlessly change power to bring whatever you chose to view into focus instantly.

As the lens becomes more rigid and inflexible with time, it can no longer change its focus easily, leading to the need for reading glasses or bifocals some time in the mid-forties. As the lens ages, it becomes cloudy — and when it begins to obscure the vision, then it is considered a cataract.

When this lens is removed during cataract surgery, a new lens must be implanted — much like if you removed a lens on a camera, you would have to put a new one on before you could expect to take a photo.

When deciding which lens is ideal for you, consider the following:

  1. How important is it for you to minimize your need to wear glasses?
  2. Is it more important to you to perform near tasks, like reading or distance tasks, such as driving and watching TV.

Current lens choices:

  1. Monofocal Lens: This is the most versatile and most widely implanted lens by far. It has a single refractive power. Measurements of your eye are taken to determine the power of the implant needed to give you the desired refractive result. A popular choice with the monofocal lens is monovision. With monovision, a monofocal lens is used to allow one eye to see distance and one eye to see near. This allows for most tasks to be done without spectacles. If better vision is required (for driving at night, for example) glasses can be used for those more demanding situations.
  2. Toric Lens: The toric lens addresses astigmatism. The astigmatic error due to the cornea is not alleviated with cataract surgery. A toric lens has different refractive power, along different portions of the lens. This lens has to be lined up with the axis of the patient’s corneal astigmatism. Correcting the astigmatism with the toric lens allows patients with corneal astigmatism to be more spectacle independent. This lens can also be used for monovision.
  3. Multifocal Lens: These implants use the optical principle of diffraction to divide the incoming light, providing both a distance and near focal point. Using this lens, both eyes can be set up in a similar fashion, and both eyes can function at both distance and near. Since the light is divided into two focal points, there is some degradation of the quality of the image, and this can decreased contrast sensitivity, a more sensitive measure of vision. These lenses also produce significantly more glare at night — so if night driving is an important task, these lenses are not ideal. The optical aberrations produced by these lenses cannot be corrected by simply wearing glasses. Recently, extended range of focus lenses have been introduced as variants of multifocal lenses that attempt to minimize the downsides of a multifocal lens.

Only you can determine when or if you would like to be spectacle independent after cataract surgery. The evaluation and discussion with your ophthalmologist will determine what is ideal for you.

Cataract surgery is indeed a modern miracle.  Choosing the correct implant for you will ensure you get the most out of your surgery.


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Age-related macular degeneration is one of the most common causes of blindness in older adults — but that doesn’t mean it’s inevitable. Early detection can be the key to saving your sight, and it’s easier than you think. In fact, your best line of defense against macular degeneration may be something you’re already doing: getting regular exams with your eye doctor here in Hamilton, NJ.

If you’re over 65, the American Academy of Ophthalmology recommends getting a regular eye exam at least once every 2 years, even if you don’t have any symptoms. In fact, this is a good schedule for anyone to maintain, because it helps your provider identify any changes in your eyes quite early on. Eye exams check for much more than macular degeneration, too. During a routine eye exam, your provider also checks for evidence of other eye disease, such as glaucoma, cataracts, and other retinal conditions.

You can easily screen yourself at home for macular degeneration with this easy test.

Take a look at the grid pictured here. Sitting about 18 inches away from your screen, focus on the dot in the middle of the grid. Cover your left eye and look at the dot, then cover your right. If at any time the boxes in the grid appear distorted, misshapen, or blurry, contact us so we can perform a more in-depth eye exam.

Left untreated, age-related macular degeneration can cause rapid and irreversible sight loss. But by simply seeing your eye care provider, you’re doing your part to make sure you retain excellent vision well into old age!



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Over 25 million Americans suffer from dry, irritated eyes, making it the number-one complaint seen by eye doctors. Our Hamilton, New Jersey practice is no different. Symptom severity can vary from a mild intermittent nuisance to severe pain and loss of vision. Although the condition cannot be cured, advances in treatment options allow most symptoms to be brought under control, restoring comfort and preserving vision. If left untreated, dry eye progresses over time.

How Dry Eye Happens

The tear film is a complex solution made up of mucous, salt water and oil. It functions to protect the surface of the eye, keeping it moist and lubricated. This complex fluid washes away allergens, infectious bacteria, and viruses. This plays into the inner workings of the eye.

Much like a recipe, poor quality ingredients (mucous, salt water, and oil) together with improper proportions produces a poor tear film incapable of protecting the eye. The corneal surface begins to break down, causing eye redness and irritation. Environmental stressors such as heat, low humidity, wind, and allergens exacerbate the symptoms of dry eye.

Dry eye is a low-grade inflammation of the surface of the eye. A treatment plan must be tailored to the individual based on the intensity of the symptoms and findings of the eye exam.

The Prevailing Treatment Methods

At our Princeton-area ophthalmology practice, we have several approaches for treating dry eye. In each case, the goal of treatment is to increase the volume and quality of the tears.

  • Artificial tears and ointments: These provide the first line of defense. They do not alter the course of the dry eye itself, but they do provide temporary relief by coating the corneal surface.
  • Eyelid hygiene: Keeping the eyelids clean decreases the bacteria that normally inhabit the eyelids. These bacteria release toxins that irritate the eye. Baby shampoo, antiseptic wipes, or solutions will decrease the bacterial load on the eyelid and improve symptoms. Antibiotic drops may sometimes be added to decrease the number of bacteria on the eyelid skin.
  • Blocking the tear ducts: The tear ducts (one for each eyelid) drain away the tears. Blocking them keeps the tears in contact with the eye longer and slows the egress of tears, keeping the eye more moist.
  • Anti-inflammatory medications: Because the underlying cause of dry eye is inflammation, medications for inflammation can improve signs and symptoms of dry eye. Steroid drops provide rapid relief of symptoms, but they can only be used for short periods due to a possibility of causing glaucoma or cataracts. For long-term treatment, anti-inflammatory drops RESTASIS® and Xiidra® are now available.

Dry eye is an exceedingly common condition that can manifest as only a minor nuisance — but in the most serious cases, it may lead to severe visual loss. That’s why we recommend coming in for a consultation if you are experiencing symptoms. There is currently no cure for dry eyes, but treatments can improve comfort and prevent visual loss.


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Cataracts develop gradually, and it can be difficult to know when cataract surgery is needed. Our eye doctors in Hamilton, Princeton, and other central New Jersey communities see men and women daily who wonder if it’s time to undergo surgery to improve their blurred vision.

Cataracts are the most common cause of vision loss in people over age 40, and the condition currently affects more than 22 million Americans. And as our population grows older, more than 30 million Americans are expected to have cataracts by the year 2020. So, how do you know if you’re at risk? What are cataracts actually like? And how do you decide that it’s time for surgery?

Risk Factors

Anyone can develop cataracts, but there are certain risk factors that make it more likely for someone to develop a cataract:

  • Family history of cataracts
  • Diabetes
  • Smoking
  • Extensive exposure to sunlight
  • Suffering a serious eye injury
  • Prolonged use of steroids, especially combined use of oral and inhaled steroids

Wearing sunglasses that block the sun’s UVA and UVB rays can reduce your risk of developing cataracts, as can avoiding smoking (or quitting if you are a smoker). In an earlier blog post, we wrote about recent studies showing that women who undergo hormone replacement therapy have increased chances of needing cataract surgery in the future, as well. As we noted, the research suggests a cautious approach to hormone replacement therapy.

Cataract Symptoms

In its initial stages, a cataract is very small, and you may not even notice any change to your vision. As it develops over time, though, vision begins to blur. As the cataract grows, it becomes increasingly difficult to see. Someone with a cataract may notice light from a lamp or the sun seems glaring, or that oncoming headlights at night cause more glare than before the cataract developed. Different types of cataracts also have slightly different symptoms that may become noticeable at different times.

Timing of Cataract Surgery

Deciding whether to get cataract surgery is a conversation you’ll need to have while consulting with an ophthalmologist. It often depends on your lifestyle and daily activities. Getting annual vision tests after age 65 will help ensure the surgery is performed at the appropriate time, as well, because regular check-ups will tell you if cataracts are developing. The American Academy of Ophthalmology™ has an online consumer guide to cataract surgery with helpful information for men and women considering the procedure.

At Outlook Eyecare, we recommend a baseline eye exam for anyone older than 40, even people who aren’t considered at risk for developing cataracts. You can [cert] request a consultation [/cert] to meet with one of our eye doctors or call us at (609) 409-2777 in Monroe Township, (609) 419-1920 in Princeton, or (609) 587-4700 in Mercerville.


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Steroids are a broad, versatile group of drugs that effectively reduce inflammation anywhere from the lungs to the skin. If you have asthma, COPD, or even seasonal allergies, you may rely on inhaled or oral steroids to keep you feeling your best. But a recent study links steroids to the development of cataracts, and it’s something that we want our cataract surgery patients here in New Jersey to be aware of.

What the Study Found

The study followed more than 3,600 adults over the course of a decade. The study found that the risk of cataract development was significantly elevated in people who met all of the following criteria at the beginning of the study:

  • Had ever used inhaled steroids
  • Had used oral steroids for at least 1 month
  • Had no pre-existing cataracts

Why You Shouldn’t Be (Too) Worried

Only 10 people involved in the study fit these criteria, but 7 of them had developed cataracts by the end of the study. That’s more than a chance relationship, and you would be right to conclude that using both inhaled and oral steroids has a significant.

Steroid use is more closely associated with a specific type of cataract called a subcapsular cataract. This type of cataract occurs farther toward the rear of the eye, as opposed to nuclear cataracts (the most common variety) that develop around the nucleus of the lens. Subcapsular cataracts do cause the same symptoms, including cloudy visual disturbances, increased nighttime glare, and less vibrant colors.

While these results are concerning, it’s also not yet safe to say that anyone who uses a combination of oral and inhaled steroids will eventually develop cataracts. That said, if you regularly use both oral and inhaled steroids, we recommend seeing your ophthalmologist to further evaluate your risk.

At that point, you’ll need to weigh the benefits of continuing to take the steroids against your chances of developing cataracts. This is not meant as a recommendation to stop taking them — we simply wanted to bring it to our patients’ attention. Do not stop taking any medications unless you’ve spoken with your doctor.




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Monroe Township
Outlook Eyecare
5 Centre Drive #1B
Monroe Township, NJ 08831
Phone: (609) 409-2777


Visit us anytime

Princeton
Outlook Eyecare
100 Canal Pointe Boulevard #100
Princeton, NJ 08540
Phone: (609) 419-1920



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2010 – 2018 Outlook Eyecare © All rights reserved.