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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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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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Glaucoma is a disease that causes damage to the eye’s optic nerve because of a fluid buildup inside the eye. Damage to the optic nerve can slowly lead to loss of vision and blindness. Unfortunately, there is nothing a patient with glaucoma can do on their own to prevent their eye pressure from rising. While there is no cure for glaucoma, there are many different treatment options that help prevent the loss of eyesight caused by high eye pressure. These treatment options include eye drops, oral medications, lasers, and surgeries.

It has been a goal to develop methods to lower eye pressure with the least amount of side effects and risk.

Dr. Coleman, a fellowship-trained glaucoma specialist here at our Princeton, NJ, ophthalmology practice, is now performing a new, state-of-the-art technique to safely lower eye pressure in patients with certain types of open angle glaucoma. The iStent trabecular micro-bypass stent is a new surgical therapy for glaucoma. iStent is the smallest medical device ever approved by the FDA and is placed in your eye during cataract surgery.

In order to maintain a normal pressure in the eye, there is fluid constantly being made and drained from inside the eye. People with glaucoma have increased resistance in their eye’s drainage system, causing a buildup of fluid in the eye. The iStent is used to bypass the highest resistance point in the drainage system, allowing fluid to drain more easily. Patients who undergo iStent implantation during cataract surgery may be able to decrease their glaucoma drop burden or even get off glaucoma drops altogether.

The iStent is so small, you won’t be able to see or feel it after surgery but it will be continuously working to help reduce your eye pressure. It stays in the eye for a patient’s lifetime.

These are very exciting times for glaucoma therapy. New, safe techniques are emerging for lowering eye pressure to help preserve a patient’s vision throughout their lifetime. Most of these techniques deal with bypassing the eye’s drainage system or decreasing fluid production in the eye.

To learn more, contact us and one of our helpful staff will schedule your appointment with Dr. Coleman.


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At some point in our lives, almost all of us experience at least some degree of floaters or flashing lights in our vision. As eye doctors, we tend to get questions about them often from our Hamilton and Princeton, NJ patients. There are various causes for these phenomena, and I will try to shed some light on this topic.

First I will start with flashes and floaters caused by problems within the eye and retina.

The inside of our eye contains a jelly called the vitreous. For most of us, there is debris within this jelly.  When light enters the eye, it hits this debris and casts a shadow on the retina, which in turn causes us to see floaters. This is a very benign condition, and although it can be annoying at times, it will not damage or harm our eyes or vision. There is also much variability from patient to patient with how noticeable these floaters are. Some patients will never notice them, while others see them constantly.

As we get a little older, the vitreous starts to contract and tugs on the retina. As it begins to tug, patients will often notice a flash of light. This flash usually lasts 1 or 2 seconds and is white in color. Eventually the vitreous will tug hard enough and separate from the retina, which is called a vitreous detachment. This leads to a different kind of floater and one that is usually larger and often looks like a circle or cobweb. This too can be very annoying but is harmless to our eyes. Over time, this floater will usually settle below our line of sight so we don’t see it as much. In certain cases, as the jelly separates from the retina, it will cause a rip or tear in the retina, which can lead to a retinal detachment. This is a more serious condition that requires prompt attention to prevent damage to the retina and vision loss. When this occurs, patients will typically notice more flashing lights, a greater number of floaters, and sometimes a veil or curtain over their vision.

In addition to flashes and floaters caused by problems to the retina, patients can experience these phenomena from other non-eye related conditions. Our eyes are an extension of the brain, so if something is disrupting the parts of the brain responsible for our vision, we can experience a number of different visual symptoms.

Transient ischemic attacks (TIAs), more commonly referred to as mini strokes, are an event in which the brain lacks proper oxygen for a timeframe of less than 24 hours. The most common cause for this is when an embolus, or blood clot, restricts the flow of blood to the brain. Depending of which part of the brain is affected, symptoms can include: weakness on one side of the body, difficulty speaking, confusion, and even visual symptoms such as loss of vision or flashing lights. There are even times when a patient can experience a mini stroke and have only these visual symptoms. Depending on where the blood clot is, these visual symptoms could affect one or both eyes. They can be described as a loss of vision, dimming of vision, or flashing lights. When patients see flashing light from a TIA or even a complete stroke, the flashes tend to last for minutes to hours, versus the retinal flashes that last for a few seconds as described earlier. This difference in duration of the flashes is important and helps to distinguish if the flashes are caused by something in the retina or brain.

In addition to mini strokes and strokes, flashes can also be a result of migraines. This type of flash is referred to as a migraine with “aura.” These flashes will often sparkle and grow in size then shrink. They will generally occur for minutes to an hour. Oftentimes, a headache will follow after the visual symptoms subside, but there are times where no headache will follow and the only symptoms are visual.

Typically, when patients come to see me complaining of flashing lights, the first concern they immediately think of is a retinal detachment. However, there are a number of different causes for flashing lights. My general advice to patients is to alert their eye care professional if they notice new flashes, floaters, or any changes to their usual floaters.

Do you have questions about floaters or flashes? Leave them for us in a comment.


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17/Jul/2015

 

It’s summer, and everyone is looking forward to those hard-earned vacation days spent at the shore or at some exotic beach in the Caribbean. It is the season of travel, outdoor sports, and family picnics. These activities, while fun, can leave us exposed to direct sunlight for longer periods of time, and we have to exercise some caution so we can diminish its adverse effects on our health.

Most of us are familiar with sun exposure’s detrimental effects on the skin and the increased risk of melanoma, so as an eye doctor, I’d like to focus instead on how such exposure can cause eye damage to varying degrees — and what we can do to protect ourselves. Here’s the advice we at Outlook Eyecare give our patients in the Princeton and Hamilton, NJ area.

How the Sun Damages Eyes

The sun emits UV-A, UV-B, UV-C, infrared, and blue light radiation.

Normally, our body makes good use of these rays as they stimulate the production of vitamin D, which strengthens our bones, immune system, and blood cell formation. Plus light helps our body regulate our sleep/wake cycle. But as with most good things, there are considerable side effects deriving from prolonged and unprotected exposure to sunlight.

Research-based evidence has shown that UV-B radiation has caused cataracts, both in high-intensity, short-term exposure (as with lasers) in animals and in chronic exposure in humans. As shown in the picture below, due to its shorter wavelength (280 nanometers to 380 nanometers), UV radiation primarily affects the front of the eye where cataracts are formed.

 

Research has also linked blue light radiation with age-related macular degeneration (AMD). Due to its longer wavelength (450 to 495 nanometers), blue light affects the back of the eye, mostly therefore causing damage to the retina, both in acute and chronic exposure. In today’s world, we use digital devices and modern energy-saving lighting that emit a high level of blue light. Our exposure to this light when accumulated over time will lead to an increase in AMD.

Here are some other conditions caused by overexposure:

  • Photokeratitis occurs after overexposure to sunlight, mainly affecting people along the beach, snow, and sand because these environments are highly reflective.
  • Pterygium is a wedge-shaped, benign, elevated tissue in the conjuctiva (clear lining that covers the white part of the eye). Its cause is thought to be exposure to UV light, and it could grow to cover the pupil (black center of the eye). Surgical removal is recommended prior to reaching the pupil.
  • Pinguecula is a yellow-white conjuctival lesion caused by UV light that does not significantly harm vision but is cosmetically unpleasant for patients.
  • Solar or macular retinopathy consists of retinal damage due to high-energy light exposure. It occurs from viewing a solar eclipse, sunbathing, high-energy laser treatments, or mental disturbances due to neurological disorders. Most of the vision is recuperated without treatment over 1 to 2 months, but recovery could last up to a year. Prognosis depends on time of exposure and visual acuity prior to exposure.

Learn how the sun can damage the eyes and what you can do to prevent it.

How to Protect Yourself

Fortunately, there are some simple steps you can take to protect yourself from sun overexposure:

  • Do not miss your yearly eye exams. A good doctor can see early signs of the conditions and the team of professionals at Outlook Eyecare will conduct a thourough exam of your eyes.
  • Wear the right contact lenses and glasses. There are many brands out there that offer blue light and UV protection. See your Outlook Eyecare team for options such as Crizal® Prevencia™ for your everyday eyewear and Xperio UV™ for your sunglasses needs.
  • Wear a hat, and try to avoid the “danger zone.” 10 a.m. to 2 p.m. in the summer. 8 a.m. to 10 a.m. and 2 to 4 p.m. in the winter.

Do you have other tips or strategies for protecting your eyes from the sun? Share them in a comment below.


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For most people, spring brings with it short sleeve shirts, outdoor activities, no more cold weather, and fun days in the sun. However, for some it means another dreaded season plagued with allergies. As an eye doctor serving Princeton, Hamilton, and other New Jersey communities, I see a lot of patients who are affected by allergies in the area.

Seasonal allergies are brought on by an immune response in certain individuals with sensitivity to certain allergens, such as pollen. As the pollens are inhaled, allergy sufferers experience rhinitis, or inflammation of their nasal passages. Symptoms include a runny nose, nasal congestion, sneezing, and itching.

If the pollens come in contact with the eyes or ocular surface, it can result in allergic conjunctivitis, otherwise know as allergic pink eye. Around 50% of allergy sufferers experience ocular symptoms. Symptoms generally include red eyes, itching, burning, and tearing. Symptoms can range from mild to very severe.

The best treatment for allergies is avoidance of the offending allergen, although this is often very difficult in regards to seasonal allergies. Some patients get relief from their eye symptoms with oral allergy medicines such as Claritin®. However, a large portion of patients require topical allergy and anti-inflammatory drops. These drops concentrate the anti-allergy effect right in the eyes. In mild cases of eye allergies, I generally prescribe drops such as Pazeo® and Lastacaft®, which helps inhibit the action of histamine and even prevents certain cells from releasing it.

I also recommend using artificial tears. They help to dilute and wash away any pollens or allergens from the ocular surface. Patients can even refrigerate the tears, which gives a soothing sensation when they use them. In more moderate cases of allergic conjunctivitis, especially when the pollen counts are high, I will add a steroid drop to help suppress the immune response. This generally produces very quick relief of symptoms.

I would urge anyone suffering from allergies to seek medical treatment. Too often, I find patients taking over the counter “get the red out” drops, because they believe these are the only therapies available. These medicines generally don’t treat the problem at its source and only mask the symptoms. I also find that I have to directly ask my patients if they experience eye allergies. Many don’t report their ocular allergy issues because they feel it’s just the norm to endure the bad months when pollens are high and their symptoms are severe. Untreated, seasonal allergies can leave a patient miserable; however, with proper medicines, patients can enjoy the spring and summer months as they should.




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


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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.



2010 – 2018 Outlook Eyecare © All rights reserved.