Vision & Eye Conditions
After practicing for more than 25 years and examining more than half a million eyes, Dr. Herschel has seen a lot of different vision and eye conditions! Some are very common and some are quite unusual. Here are the conditions that our patients most often ask about and options for treating each condition.
Vision Conditions/Refractive Errors
Nearsighted individuals have problems seeing well at a distance and depend on glasses or contact lenses for clear vision. The nearsighted eye is usually longer and steeper than a normal eye. Therefore, when light passes through the cornea and lens, it is focused in front of the retina making distant images appear blurred. Because myopic people can see objects up close, myopia is commonly referred to as nearsightedness. Myopia can be surgically corrected in younger adults with LASIK, PRK, Visian ICL (high myopia) and in older adults with premium lens implants.
Astigmatism is an asymmetric steepening of the cornea. Instead of the eye being more symmetrically shaped like a basketball, its shape resembles a football. This causes light to be focused unevenly on the retina making images appear blurry or shadowed. This type of refractive error is very common and can accompany both nearsightedness and farsightedness. Astigmatic individuals depend on glasses or contact lenses for clear vision. Astigmatism can be surgically corrected with corneal relaxing incisions, laser vision correction for younger adults, and premium lens implants for older adults.
Farsighted individuals may have difficulty seeing up close and depend on glasses or contact lenses for clear vision. This is a separate issue from those unable to see up close beginning in their mid-40s (see presbyopia). The farsighted eye is usually slightly shorter than a normal eye with a flatter cornea, thus light entering the eye focuses behind the retina making near images appear blurred. Because hyperopic people can generally see objects far away or at a distance, hyperopia is commonly referred to as farsightedness. In younger adults, lower hyperopia can be surgically corrected with laser vision surgery. Higher hyperopia can be corrected with premium lens implants. In older adults, hyperopia can be surgically corrected with premium lens implants.
Presbyopia is a condition that typically becomes noticeable for most people between the ages of 40 and 50. It is the first stage of the natural aging process of Dysfunctional Lens Syndrome (DLS). In children and young adults, the lens inside the eye can easily focus on distant and near objects because it is flexible, but with age, the lens loses its flexibility and, therefore, its ability to focus properly. As a result, reading glasses or bifocals are typically needed by the mid-forties. The lens is still clear at this stage. Besides reading glasses, presbyopia can be helped by use of monovision and multifocal contact lenses as well as surgical procedures such as monovision (blended vision), laser vision correction, multifocal lens implants, and corneal inlays.
Contact Lens Damage
A very common eye condition that Dr. Herschel sees in his vision correction practice is corneal damage from contact lens wear. Using advanced diagnostic technology, Dr. Herschel takes images of his patients’ corneas. These images clearly show the extent of the injury to the cornea, when it is present. Many patients, even ones who are meticulous about their contact lens regimens, are genuinely surprised by the amount of corneal damage they have.
Healthy corneas are essential for achieving your best possible surgical results, and Dr. Herschel will tailor a treatment plan to help you get your corneas in the best possible condition before surgery. Since Dr. Herschel is both a cornea and vision correction specialist, he is the ideal surgeon to assess and treat your corneas. The treatment plans are simple, easy to follow, and effective. Every patient benefits from these pre-operative treatments. If you wear contact lenses, you may want to check out RianeMary and Nadia’s online reviews.
Dry Eye Syndrome
Dry eye occurs when the eye does not produce tears properly (aqueous tear deficiency) or when the tears are not of the correct consistency and evaporate too quickly (evaporative tear loss). Inflammation of the surface of the eye may occur with dry eye, and in severe cases damage to the cornea can occur if left untreated.
Tears are made of proteins (including growth factors), electrolytes, and vitamins that are critical to maintain the health of the eye surface and to prevent infection. There are three layers of tear film, the outer oily or lipid layer produced by the Meibomian glands, the middle watery layer produced by the lacrimal glands, and the inner mucous layer produced by goblet cells.
The aqueous deficient eye’s lacrimal glands fail to produce enough “water” to maintain a healthy corneal surface. In evaporative dry eyes the Meibomian glands, located in the eyelids, produce the lipid or oily layer and may become inflamed or even blocked, which allows the tears to evaporate more quickly. Eyes may “water” a lot, as they try to compensate for dry eyes.
Dry eye symptoms may include blurred vision, stinging or burning of the eye, a feeling of grittiness or like sand is in the eye, excess tearing, pain and redness, light sensitivity, stringy discharge, and uncomfortable contact lens wear. Sufferers may experience blurred vision that gets better after blinking or using artificial tears. With dry eyes, one may not be able to read or work on a computer for extended periods of time without discomfort or eye fatigue. This is in part due to the fact that when people are doing these tasks they forget to blink. Blinking carries tear film back over the surface of the eye, the cornea, providing a healthy layer of tear film.
Dry eye can be a temporary or chronic condition. A number of different factors may contribute to dry eye: contact lens use, age, medical conditions, medication/supplement use, fluctuating hormones, allergies, eyelid inflammation (blepharitis), and environmental factors.
It is very important to have a healthy corneal surface prior to any vision correction procedure. Since dry eye is so common in the general population, it is not surprising that many of our patients, like Nick, a greenstein, and Matt, are treated for it prior to their vision correction procedures. As a cornea specialist, Dr. Herschel personally evaluates your eyes, symptoms, and medical history to understand the underlying causes of your dry eye condition. He will create a plan to manage and improve your condition to help you get your corneas in the best possible condition prior to surgery, so that you will have the best possible vision after surgery.
The treatment Dr. Herschel prescribes for you will depend on your underlying condition. Common treatment options include: lubricating eye drops and ointments that temporarily relieve some symptoms, topical and oral antibiotics to kill bacteria and reduce inflammation, Restasis® or Xiidra ® eye drops that increase tear production, punctal plugs that keep tears from draining so quickly, eye health vitamins, eyelid scrubs to improve hygiene and reduce inflammation, BlephEx to remove the inflammatory biofilm on the eyelids, Bruder moist heat compresses to reduce blockages of Meibomian glands, gland expression to clear ducts, and LipiFlow to remove blockages of the Meibomian glands and increase the natural oils in tears.
Ensuring that your corneas are in the best possible condition before surgery, so that you have the best possible outcome after surgery is an essential part of our philosophy at Herschel LASIK. Like he does with all his patients, including Suzanne and Melissa, Dr. Herschel will insist that your corneas be in the best condition possible prior to surgery—even if that means delaying your surgery to treat an underlying condition. Protecting your eye health and enabling you to achieve your best possible vision outcome is the core of what we do.
Cataracts (Dysfunctional Lens Syndrome)
As people age, the lenses in their eyes become less flexible and begin to cloud (Dysfunctional Lens Syndrome (DLS)). Early on, the lens begins to lose its flexibility, but it is still clear (presbyopia). This is when people need readers for near vision or use bifocals or progressives. At the next stage the lens continues to lose flexibility and begins to cloud (early or beginning cataracts). People may have difficulty reading in dim light or driving at night. The quality of vison also decreases, and people may experience halos or glare. At the last stage, cataracts have formed and people experience a significant decrease in the quality of their vision somewhat akin to looking through foggy, yellow glass.
Dysfunctional Lens Syndrome (DLS)
At the presbyopic stage, surgical treatments include monovision (blended vision), laser vision correction, multifocal lens implants, and corneal inlays. At the middle stage, Refractive Lens Exchange (RLE) with premium lens implants can restore clear vision and prevent cataracts from developing. In this procedure, the clear or slightly cloudy lens is removed and replaced with a new technically advanced lens. At the latest stage, Refractive Laser-Assisted Cataract Surgery (ReLACS) with premium lens implants can restore clear vision. In this procedure, the cataract is removed and is replaced with a new technically advanced lens.
The treatment that is best for you will depend on your age, the condition of your lenses, your lifestyle, and your vision correction goals. Dr. Herschel will evaluate your eyes and discuss treatment options with you that best meet your individual needs and vision goals.
Keratoconus is a common eye condition that occurs in approximately 1 in 750 Americans. Keratoconus can begin at puberty and continue to progress into the thirties or early forties at which time progression slows and often stops. With Keratoconus, the cornea becomes weak, progressively thinner, and irregular in shape resulting in a distorted image being projected onto the retina and high levels of astigmatism. People with Keratoconus may experience blurred vision, sensitivity to light, and difficulty seeing at night.
Since the cornea is irregular and cone shaped with Keratoconus, glasses do not adequately correct vision because they do not conform to the shape of the eye. Patients with Keratoconus see best with rigid contact lenses since these lenses provide a clear, rigid surface in front of the cornea allowing the light rays to be projected to the retina without distortion. If the condition progresses to a severe level, a corneal transplant may be required.
Many patients are initially unaware they have Keratoconus and see their eye doctor because their glasses or contacts are no longer providing clear vision. They may also be experiencing unexplained, increasing astigmatism. Keratoconus is most often diagnosed by a cornea specialist, like Dr. Herschel, who may see typical findings when examining the patient at the slit-lamp. In early forms of the disease, there may be no obvious findings on slit-lamp evaluation, and the diagnosis is made by evaluation of computerized topography. Because Keratoconus is progressive, early detection and treatment are very important.
Fortunately, significant technical advances have been made in the treatment options available for Keratoconus. They include: corneal collagen cross-linking, Intacs® corneal implants, topography-guided PRK, and conductive keratoplasty. These treatments are designed for two different purposes: to slow or stop the progression of Keratoconus and improve visual acuity. To achieve both goals, the treatments are most often done in combination. After treatment, patients may still need glasses or contact lenses to see clearly.
The treatment that is best for you will depend on the stage of your Keratoconus. Dr. Herschel will evaluate your eyes and discuss treatment options with you that best meet your individual needs.
Herschel LASIK has more experience in diagnosing and treating Keratoconus than any eye center in Central Florida. Dr. Herschel served as a principal investigator on an FDA multi-center Phase III clinical trial in which corneal collagen cross-linking was used to treat patients with Keratoconus or corneal ectasia. This technology was approved by the FDA in 2016, and we use it in our center to treat our patients. See Dr. Herschel’s clinical trial experience.
Blepharitis is a common eye condition in which the eyelid margins and eyelashes become inflamed and irritated. It may be associated with a bacterial eye infection, dry eyes, allergic reactions, excessive production of oil by glands in the eyelids, poor eyelid hygiene, or certain types of skin conditions such as acne rosacea.
There are two forms of blepharitis: Anterior blepharitis, affecting the outside front of the eyelid where eyelashes are attached and posterior blepharitis linked to dysfunction of the Meibomian glands within the eyelids that secrete oils to help lubricate the eye. It is common to have a mixture of both anterior and posterior forms of blepharitis at the same time, but in different degrees of severity.
Symptoms of blepharitis can include burning, flaking, crusting, tearing, irritation, itching, redness in eyelid margins, and a foreign body or “gritty” sensation.
If you are diagnosed with blepharitis, Dr. Herschel will likely recommend an ongoing regimen of eyelid hygiene that may include over-the-counter lid scrubs or other cleansing regimens. Eyelid hygiene is the cornerstone of treatment for most cases of blepharitis, but some conditions may require supplemental treatment with topical or oral medications. In some cases of posterior blepharitis, Dr. Herschel may recommend nutritional supplementation with omega-3 fatty acids, such as flaxseed oil, to aid healthy functioning of the Meibomian glands that provide essential lubrication for eye and eyelid comfort.