Ophthalmology and Eye Care in Chevy Chase, Maryland
Preventive Eye Care
Let’s face it; most people don’t look forward to eye exams. There are those eye drops, the “better one, or better two?” questions, and sitting around while your vision gets fuzzy. Besides, if you see well and your eyes don’t hurt…what’s the problem?
Actually, while some eye diseases let you know something’s wrong – with symptoms such as red eyes, light sensitivity, or flashing lights – many serious, vision-threatening problems have no warning signs. Much like high blood pressure, most forms of glaucoma, for example, produce no symptoms whatsoever until some vision has been permanently lost. This is why glaucoma is often referred to as “the thief in the night.” Proper eye care and checkups can help prevent your eyesight being taken from you.
Annual eye exams can also detect diabetes, hypertension, retinal holes or tears, and other important treatable medical conditions. Today’s sophisticated medical equipment, in the hands of your expert eye doctor, can detect the earliest signs of a problem. This is why the American Academy of Ophthalmology recommends yearly eye examinations for adults over 50, and every two years for younger people. Early detection and treatment of these symptomless conditions can protect and preserve your precious vision for a lifetime. Learn more about preventive eye care by contacting our eye care practice in Chevy Chase, Maryland.
Other Eye Care Services
- Washington Eye is a full spectrum eye care clinic that offers patients a wide variety of treatments and services. In addition to the eye care services highlighted above, we also provide treatment for corneal disorders and dry eye syndrome relief as well as low vision aids and contact lens sales and fittings. If you have a specific eye condition or eye care need, contact our eye care practice in Chevy Chase, Maryland, today to find out how we can serve you.
Contact Lenses, Eye Diseases and Problems
Contact Lens Do’s and Dont’s | Glaucoma | Macular Degeneration | Orbital Disease
Eyelid Skin Cancers | Neuro-Ophthalmology | Blepharitis | Dry Eye Syndrome
Contact Lens Do’s and Dont’s
Contact Lens Q & A
The rules for contact lenses are the same ones your mother had for underwear.
- If it’s dirty, don’t wear it.
- If it’s torn, don’t wear it.
- If it feels funny, find out why. Don’t keep wearing it.
- Don’t share with your friends.
- Don’t put it in your mouth.
- Get what fits, not what looks good.
- Don’t wear it for days without cleaning it.
Q: Can I wear my sister’s lenses?
A: Contact lenses are available only by prescription for a reason. You need to see your eye doctor to find out if it’s safe for you to wear contact lenses. Even if you’ve already been told it is okay to wear them, there are several good reasons to avoid wearing someone else’s contact lenses. If you are thinking of wearing contact lenses your sister has already worn, forget it! Even if she has disposable lenses, chances are good that your eyes and your sister’s don’t have the same prescription, which means you won’t see properly with her lenses and they could seriously injure you. If you want to try contact lenses, your doctor can easily set you up with a trial pair.
Q: Sometimes my roommate sleeps in his lenses. Is that okay.
A: There are all kinds of contact lenses. Some let more oxygen reach your eye, so they are safer. Unless you are wearing contact lenses designed for continuous wear and your doctor has told you that it is okay to sleep in your lenses, you should not sleep in them. Your eye doctor will prescribe the type of lens and wearing schedule that are best for you and your eye health.
Q: The generic version of my solution is cheaper. They are the same, right?
A: Not really. The packaging might say “Compare to…” (Your brand), but that does not mean they are identical. The composition of generic (store brand) products can change depending on the company the store contracts with to produce it. These subtle formulation differences can affect healthy, comfortable contact lens wear. Serious eye infections caused by certain brands of lens solutions have been in the news recently.
Q: My eyes look so bloodshot. How can I make them look better?
A: Dry, red eyes are never normal. See your eye doctor for a diagnosis. Your doctor can treat these problems – usually without having you stop wearing your lenses – and will find a convenient schedule that fits your lifestyle.
Q: My friend’s doctor says she got an infection because she didn’t handle her lenses properly. What does that mean?
A: Contact lenses are a safe form of vision correction when used as directed. But they are considered medical devices, and improper care of your contact lenses could lead to infection. Hygiene plays a key role in contact lens safety. Contact lens wearers need to keep their hands, contact lens case and lenses clean. Clean your contact lenses immediately after you remove them from your eye, and always clean and disinfect your lenses according to the manufacturer’s directions. Always use fresh solution each time you put the lenses back in the case. “Topping off” is not a healthy practice. Your doctor will tell you how often to replace the case. New ones are available at any pharmacy and often at your doctor’s office. Finally, follow your doctor’s instructions. Replace your contact lenses as often as your doctor prescribes, even if you are using proper hygiene. Don’t wait for your lenses to start to irritate your eyes and “bother” you. The idea is to replace the lenses on a regular basis to help you stay safe, comfortable and seeing great all the time. Always use the solutions your doctor prescribes, too. If you switch solutions, you could experience problems, including lens discomfort.
Q: I think I’m cleaning and disinfecting my lenses correctly, but how would I recognize an infection?
A: As long as you are following your doctor’s instructions, your lenses should be clean, safe and comfortable. But any time you think you may have an eye-related problem, you should remove your contact lenses and call your doctor right away.
These are the symptoms of eye infections:
- Sudden blurred vision
- Red, irritated eyes
- Uncomfortable lenses
- Pain in and around the eyes
Be sure to see your doctor immediately if you have any of these symptoms and you do not feel better right away after removing your lenses. Infections are easily avoidable and typically minor. If you get one, your doctor will help.
Boarding a plane with your contact lenses?
Planning a trip? Here are some tips for contact lens wearers.
PLAN AHEAD: Pack eyecare needs with the climate and your activities in mind. Allergens, altitude and air quality can all affect your contact lens comfort. Rewetting drops can help alleviate dryness from the environment.
PACK UP: Your lens care travel kit should include your cleaning and disinfecting solution, rewetting drops and a spare pair of lenses. Put everything in a separate pocket or container in your luggage.
CARRY ON: The air inside an airplane is very dry. Keep a small bottle of rewetting drops in your carry-on bag, along with a lens case and your spare eyeglasses. That way, you can refresh your eyes or remove your lenses whenever you want.
FLY AWAY: Onboard the plane, aim your vents away from your face to keep your eyes from getting dry. And remember to drink water. It’s good for you and your eyes. Finally, if you’re on a long flight, remind yourself to use rewetting drops frequently. Consider wearing your eyeglasses on any long flight. It can seem like time stands still on a plane, but your eyes know better. Bon Voyage!
Glaucoma
The New Tests and Treatments for Glaucoma
Glaucoma, the most preventable cause of vision loss in the developed world, affects millions of Americans, often without any symptoms until vision has been lost. Routine eye examinations and testing for glaucoma could prevent the overwhelming majority of cases of vision loss. Pressure in an eye with glaucoma damages the optic nerve in the back of the eye and, if untreated, can lead to vision loss. Several new tools have recently emerged from ophthalmology research laboratories to become part of the state-of-the-art eye care that doctors at Washington Eye in Chevy Chase, Maryland, provide. Dr. Howard Weiss, Dr. Arthur Schwartz, and Dr. Kenneth Schwartz have been closely involved with the research and clinical trials of several of these ophthalmology developments.
“I’ve been very fortunate and honored to be selected to participate in these exciting studies,” said the typically modest Dr. Weiss, who was one of the first doctors to perform collagen wick glaucoma surgery in the clinical trials. “Arthur Schwartz and I are very excited about these new developments, which will allow us to diagnose and treat patients more effectively than ever.”
New Ways to Detect Glaucoma
The new Optic Nerve Imaging device takes a 3-dimensional image of the optic nerve in the back of the eye. This is the nerve that carries vision from the eye to the brain and is the part of the eye damaged in glaucoma. In a matter of seconds, as many as thirty million measurements are made of the optic nerve and its surrounding structures. The remarkable resulting images can be used to identify glaucoma and follow known glaucoma patients.
HRT Analysis of Optic Nerve Deterioration
Corneal Thickness has been shown in an NIH-sponsored study to be of great importance in the care of glaucoma patients. Drs. Schwartz and Weiss and many of their patients at Washington Eye volunteered to participate in this study. Corneal Pachymetry measures the thickness of the cornea which has been found to influence the accuracy of pressure measurements. Corneal thickness also predicts which patients with high pressure are more likely to have damage to their optic nerves. This painless ultrasound test takes only a few minutes for our ophthalmic technicians to perform. Although Medicare does not cover the cost of corneal pachymetry, we have been able to hold our fee to a minimum to be sure it is affordable for all.
New Glaucoma Treatments
Selective Laser Trabeculoplasty is a new type of laser glaucoma treatment, which was approved by the FDA in March of 2001. We are one of only two eye care centers in the Washington area offering this treatment.
SLT lowers eye pressure by improving the fluid outflow from the eye. It is sometimes called a “cool laser” because the ultra-short pulses of very low energy generate no heat. Selective Laser Trabeculoplasty appears to have the same benefit as the classic treatment, argon laser trabeculoplasty, in lowering pressure, but without the heat damage and scarring. It is believed that SLT, unlike argon laser trabeculoplasty, may be repeated safely many times and may also be used in patients who have had previous argon laser trabeculoplasty. It has been performed successfully in thousands of ophthalmology patients throughout the world.
Improved Eye drops, which are easier to use and may have fewer side effects, are another tool in the treatment of glaucoma. One of these, a once-a-day, highly effective medication called Xalatan®, can be dispensed with a free convenient eyedropper to make it easier to apply the eye drops.
The Collagen Wick was developed in Europe and was approved by the FDA in October of 2001. Unlike conventional surgery, this patient-friendly treatment does not require surgery inside the eye. Like conventional glaucoma surgery, eye pressure is reduced by the creation of a new drainage channel. The Collagen Wick helps establish flow and then dissolves after approximately six months, leaving a well-established drain in its place. Having performed this operation for over two years, Dr. Weiss is one of the most experienced surgeons on the East Coast in this ophthalmology procedure.
Please forward all comments, questions, and requests for Gleams to:
Glaucoma Research Foundation
490 Post Street Suite 830
San Francisco, California 94102
or call (800) 826-6693 or (415) 986-3162.
http://www.glaucoma.org
Writer: Lynn A. Whitmore
Library of Congress catalog number 88-207450
ISBN 0-9621579-0-2.
Support for this information provided by Allergan, Inc.
Macular Degeneration
What is Macular Degeneration?
Macular Degeneration usually occurs in people over 60. There are two types of macular degeneration: atrophic (“dry”) and exudative (“wet”). As people age, parts of the retina may deteriorate.
The Effects of Macular Degeneration
Macular degeneration affects the area of the retina called the macula, the part of the eye responsible for central vision. A person with this condition has difficulty seeing detailed objects such as small print, faces, or street signs. The affected areas of the macula often cause scotomas, or small central areas of vision loss. These areas may cause objects to appear faded, disappear, or look distorted. Straight lines may look wavy. Peripheral vision is not affected and macular degeneration does not cause total blindness.
Possible Causes and Risk Factors
Although the cause of this condition is not clear, possible causes and risk factors may include: lack of certain vitamins and minerals, breakdown in circulation to the retina, untreated health conditions such as high blood pressure, excessive exposure to ultraviolet light from the sun, heredity, and cigarette smoking.
Diagnosing Macular Degeneration
Your eye care doctor can diagnose macular degeneration during a comprehensive eye examination. Ophthalmoscopy is a procedure that allows your doctor to view the back of your eye, including the macula. If macular degeneration is suspected, a fluorescein angiogram may be performed. In this procedure, dye is injected into your arm and travels to the eye. Damaged areas become highlighted to help determine which type of macular degeneration is present, wet or dry.
Treating Macular Degeneration
In wet macular degeneration, new blood vessels growing near the macula may leak or bleed. If this type is present, laser treatment can help to seal the leaky vessels, but cannot repair damage that has already occurred. Laser treatment is not helpful for dry macular degeneration. Many patients with either type of macular degeneration can benefit from low vision rehabilitation. Optical devices can be prescribed to help you use your remaining vision more effectively. Some vitamin supplements appear helpful for macular degeneration as well. Your doctor can give you further information and refer you to a low vision care provider.
For a comprehensive online resource on macular degeneration, please see the Macular Degeneration Partnership website at www.macd.net.
Orbital Disease
Thyroid-Related Eye Disease
Thyroid eye disease refers to changes in the tissues around the eye that occur in many patients with thyroid problems. These eye changes involve not only the eyelids, but also the eye muscles and the nerves behind the eye. Because a wide variety of different eye problems can occur in such thyroid patients, ranging from very minor eye irritation to potential blinding conditions, it is very important that thyroid patients be followed closely.
Dr. Goodglick is one of only a few ophthalmology specialists in the country who have expertise in eyelids, eye muscles, and optic nerve conditions. Thyroid patients are frequently referred to him for evaluation because of his comprehensive knowledge.
Symptoms of Orbital Disease
Common symptoms of a thyroid patient with eye involvement include eye irritation, burning, light sensitivity, and tearing. In addition, eye muscle involvement can cause double vision, and involvement of the fat and tissues around the eye can cause bulging of the eyes causing the eyes to stare. There can also be swelling around the protruded eyes. Severe involvement can cause decrease in vision as well as pain.
It is important to note that the involvement of the thyroid gland is independent of the involvement of the eyes. Maintaining a normal thyroid status is important but does not entirely prevent a patient from developing eye symptoms as well. Patients with thyroid problems, therefore, need to be followed closely by a specialist such as Dr. Goodglick, even when their thyroid levels are normal. Fortunately, the vast majority of thyroid patients have only mild eye problems, which can be dealt with very conservatively.
Treatment Options
There are a variety of treatments used for thyroid-related eye disease, and they need to be carefully tailored to the particular symptoms and severity of each patient's condition. Dr. Goodglick welcomes the opportunity to discuss the treatment options available for each patient individually. Please contact our ophthalmology and eye care center in Chevy Chase, Maryland, to schedule an appointment.
EYELID SKIN CANCERS
A variety of skin cancers commonly occur on the eyelids and around the eyes. Because of their common location, management of these requires taking into account both dermatologic and ophthalmologic concerns. Dr. Goodglick works closely with dermatologic surgeons in both the evaluation and management of such problems.
Some eyelid tumors can be removed by direct excision and reconstructive surgical techniques performed by Dr. Goodglick at the local hospitals and surgery centers. Often, such procedures are performed in conjunction with dermatologic surgeons, called Mohs surgeons, who are specifically trained in special techniques of pathology for evaluating biopsy specimens of skin tumors.
It is important to evaluate suspicious looking eyelid growths in order to prevent eye, eyelid, and skin complications that might occur should they continue to enlarge. If you have questions, contact our ophthalmology and eye care center in Chevy Chase, Maryland, today.
Neuro-Ophthalmology
What is Neuro-Ophthalmology?
A subspecialty of general ophthalmology, neuro-ophthalmology deals with problems relating to the central nervous system, blood vessels, and the many systemic diseases that affect the eye secondarily. These diseases include strokes, thyroid eye disease, orbital tumors, brain tumors, diseases of the blood vessels and heart, multiple sclerosis, optic neuritis, as well as diseases of the muscles such as myasthenia. Because of this, the neuro-ophthalmologist works closely with physicians and health care professionals in many other fields.
Symptoms That Require a Neuro-Ophthalmologist
Common symptoms for which a patient is sent to a neuro-ophthalmologist include double vision, drooping eyelids, eye pain, loss of vision, and loss of visual field and peripheral vision.
The Neuro-Ophthalmologic Exam
Because of the complexity of neuro-ophthalmologic problems and the relationship to other aspects of the body, the neuro-ophthalmologic examination needs to be in-depth and usually takes significantly longer than a routine eye examination. Frequently, additional tests need to be performed such as visual field testing, head scans such as an MRI or a CAT scan, or other tests of the heart, blood vessels, and retina.
Blepharitis, Styes, and Chalazia
Blepharitis (blef'ah-ri'tis) is a very common skin condition that affects the skin and oil glands of the eyelids and may inflame the eyes. "Blepharo" means “lids” and "itis" means "inflammation of."
The symptoms and signs of blepharitis may include a gritty feeling as if there is foreign matter in your eyes, reddened eyelids, especially at the lid margins, redness of the ordinarily white part of the eye (known as the sclera), tearing, ocular burning, and occasionally blurry vision. Although anyone can develop blepharitis, this condition is particularly common among people of French, German, and Scandinavian ancestry, as well as those patients whose ancestors were native to the British Isles, and in people with fair skin and a facial skin condition called acne rosacea.
Sometimes long-standing blepharitis results in clogging of the eyelid oil glands like clogged skin pores, which may then become infected. When this happens, the lid may swell and turn red and a tender lump or pimple may form in the lid called a stye. When a stye does not drain and heal completely, a non-tender, firm lump or chalazion may result. Chalazia that do not respond to treatment with hot compresses may need to be injected with steroids or surgically drained.
For most patients blepharitis is just a nuisance in terms of occasional mild, itchy, gritty eyes with redness or occasional styes. However, it can increase the risks of infection associated with contact lens use or it can preclude the use of contact lenses entirely.
Treatment of Blepharitis
Many patients with blepharitis have been treated repeatedly with strong antibiotic drops to clear up their "conjunctivitis.” This is usually not the most effective therapy for this chronic problem.
Doctors use a variety of therapies to treat blepharitis. One of the most effective treatments is a hot compress to open the clogged pores of the lid oil glands. Fill a bowl with hot water (not so hot that it burns to the touch). Dip a washcloth in the water and wring it out, fold it, and place it over both closed eyes in a lying or sitting position. As the washcloth cools, dip it back into the water, wring it out, and repeat procedure. Be careful not to open your eyes while applying the compress. Many patients tell us they like the self-heating, disposable EyeFeel pads (available at www.ocularsurface.com or 305-274-1299).
Your doctor may prescribe an antibiotic ointment to be instilled in the eyes after hot compresses. They may blur your vision, so are best applied at bedtime. A good tip for instilling these ointments is to hold the tube in your pocket or hand for 10 minutes to liquefy the product before applying it. Sometimes steroid-containing drops are prescribed when hot compresses and antibiotic ointments are not sufficient. These drops, such as Blephamide™, Tobradex™, and Lotemax™, are potent medications to be used only under the supervision of an eye doctor. Possible long-term side effects include glaucoma and cataracts. Only your doctor is able to direct you in their safe use, maximizing their therapeutic benefit and minimizing any risk.
Your doctor may prescribe tetracycline or doxycycline, which can be extremely effective not by treating any infection but by improving the oils secreted by eyelid oil glands. Tetracycline, like all medications, can have side effects. It can make some patients very susceptible to sunburn from sun exposure. It can interact with other medications such as blood thinners like Coumadin and, in rare instances, can produce liver or other more serious problems. To avoid stomach upset from these medicines, take them with food in the morning or at lunch and avoid taking them at night or on an empty stomach.
Children and pregnant women should not take tetracycline because it discolors the enamel of developing teeth. A recent study showed no increased risk in breast cancer in women taking this medicine for skin treatment
Responsible doctors are hesitant to prescribe medications unless they feel they are truly needed. If your doctor has recommended these antibiotics, then we feel strongly that the benefits of these relatively safe medications outweigh any small probability of risk associated with their use. After your condition improves, the dose can be tapered to low levels and often discontinued as long as you continue with the mainstay of blepharitis treatment, hot compresses. Blepharitis can be treated in most cases with excellent results; however, like flossing your teeth to prevent gum disease, it can take some commitment.
Dry Eyes Syndrome
Burning, redness, a gritty feeling, and eye fatigue are often signs of dry eye syndrome, the most common form of eye irritation. To see how common it really is, just take a look at the dozens of artificial tear bottles in the eye care aisle of any drugstore. Dry eyes syndrome is very common and often goes unrecognized and untreated. It is usually not a serious condition but it can be troublesome. It can interfere with contact lens wear, computer use, and other visual tasks.
Computers, LASIK, and Dry Eyes
Many factors affect normal tear production. For example, age causes a permanent decrease in tear production. Computer use, contact lens wear, LASIK, low humidity, and certain medications may cause temporary ocular dryness. Computer use, combined with contact lens wear can really cause dryness problems because people blink less often while using the computer.
The majority of patients who decide to have LASIK have relatively dry eyes. Many have chosen LASIK because of problems with contact lenses. LASIK frequently worsens dry eye symptoms for several months after the procedure.
Treatment
Most of the time, taking occasional breaks to use preservative-free eye drops, decreasing contact lens wearing time, or other simple measures recommended by your eye doctor are sufficient to treat this condition. When these are not enough, we use a simple, 5-minute, in-office technique called punctal plugs. In this painless non-surgical procedure, tiny, soft, invisible plugs are used to temporarily close off the tear drains of your lids (like closing the drain in a sink to keep the water in it longer). People tell us it sounds a bit unusual, but it really works. This treatment, which is often covered by insurance plans, has allowed many of our patients to wear their contact lenses comfortably again, work at the computer without frequent breaks, and greatly reduce their need for eye drops.
Learn more about alleviating Dry Eyes Syndrome by contacting our eye care practice in Chevy Chase, Maryland.
