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The Other Side of the Exam Chair

It was my turn to be on the other side of the exam chair.

I was sitting at home on a Sunday afternoon, when I first saw sparks of light out of the corner of my right eye.  At first, they occurred a few times an hour.  By Sunday night, they were happening a few times a minute.  They moved in curved arcs along my peripheral vision.

Since I happen to know people trained in eye care, I sent a text to the office staff to tell them what was happening.

They asked me all of the right questions:

  • Did you sustain an injury to the eye? No
  • Was there a curtain falling across my vision? – No
  • Did you see a sudden shower of floaters? – No
  • Any loss of vision? – No
  • Any pain? – No

Dr. Moran asked me, “What would you tell a patient who called with these symptoms?”  I answered, “We would tell them to call us if it gets worse, or they can answer YES to any of the above questions. We would then schedule them for a dilated exam the next day.” 

I understood everything that I was told.  It was a “classic textbook” issue.  I have spoken to patients who were experiencing the same symptoms, and explained that they should come in for an exam, but not to worry. Flashes can be a common occurrence.

But…I must admit that it felt different being the patient. Even though I understood what was happening,  I felt better after checking in with Dr. Moran and the rest of the team.

By the next morning, the symptoms had stopped. I had a very thorough dilated eye exam, and everything was normal. I knew that the sparks of lights were caused by the vitreous tugging on the retina, which is common.  It is seen more often in older adults.  I am 58, so I fit that profile.  I knew that the issue was most likely age-related.

When you are having an issue with your eyes, don’t delay, contact our office.   

We will ask you the key questions that mean the difference between an emergency, or something that can wait until you can come into the office for an exam.

You can feel confident that you are in good hands with Dr. Moran and the staff at Moran Eye Associates.  We take your concerns seriously, because we know what it is like to be on the other side of the exam chair.

P.S.  Almost two months later all is well.  I am very aware of the importance of  follow up exams, and will make sure to see my ophthalmologist regularly!  Bobbi

LASIK is All in the Family

LASIK is all in the family for brothers Andy & Gary, who both had LASIK with Dr. Moran on the same day!
We had to capture the moment, because it was a first for Dr. Moran. Although he has done LASIK on members of the same family, it was the first time in 20 years that he had a set of brothers together on the same surgery schedule.  

The brothers with their favorite LASIK Surgeon

Older brother Andy scheduled a free LASIK consult to see if he was a candidate for LASIK. He provided the inspiration for his brother Gary to make an appointment to see if LASIK was right for him.  Although the brothers had different prescriptions, they both were excellent candidates. So it made sense for Andy to go first, Gary followed twenty minutes later!
 
This pic was taken just moments after older brother Andy’s LASIK procedure, and minutes before Gary’s turn in the Laser Suite with Dr. Moran.  Everyone is smiling…and Gary doesn’t need those glasses any more!
Call our office for your LASIK consult, and bring your brother, sister, cousin, mom or dad!  Spend some quality time together, and find out if LASIK is right for your family!

Measuring Eye Pressure (IOP)

As part of your comprehensive eye exam, we check the pressure of your eye, the Intraocular Pressure (IOP).  This test, called tonometry, is one way to see if you are at risk for glaucoma. Regular screenings are a simple way to monitor your eye health.  Early detection is essential in the treatment of glaucoma, since many times there are no symptoms with increased pressure, unless it is sudden.

UNDERSTANDING EYE PRESSURE:

Increased pressure (IOP)

Inside the eye, there is a cycle of fluid production and fluid drainage.  This fluid, in the front part of your eye, is called the the aqueous humor.  The aqueous humor nourishes your eye and helps it to keep its shape.  If this cycle is out of balance, and more fluid is produced than is able to drain effectively, IOP increases.  Over time, this Increased eye pressure may cause damage to the optic nerve.  A general guideline for normal eye pressure is between 10 and 21 mm/hg.

HOW WE MEASURE EYE PRESSURE:

Measuring IOPIn our office, we measure eye pressure by instilling a drop that numbs your eye.  Using a blue light, we then use an applanation tonometer that gently touches the surface of your eye. This painless test is a very effective way of measuring your pressure.  It is helpful for the patient to relax and breathe normally while we perform this test.

Although there are many other ways of measuring eye pressure, many people are familiar with the “puff of air test”.   This test, called non-contact tonometry, uses a rapid air pulse to flatten the cornea. Your pressure is measured by detecting the force of the air against your eye.  Although we don’t use this process, often when we ask patients them to “put your chin in the chin rest and forehead against the band” they worry we are going to puff air at them. They don’t seem to like it! 

We can’t emphasize enough the importance of comprehensive eye exams. It is especially important to have an eye exam if you have a family history of eye disease, diabetes or high blood pressure. The best way to protect your vision is to come in for an exam, where Dr. Moran will evaluate your risk for disease and advise you of the optimal schedule of visits to protect your eye health.

Schedule your exam today, by calling our office at 610-628-2022, or by filling out the form on the website.

Q&A about LASIK with Intralase Technology

Patients are curious about what happens during LASIK surgery. Q&A

Dr. Moran knows that a well-informed patient makes the best medical decisions. Understanding what happens during LASIK can lead to a more calm and comfortable experience. We’ve highlighted the most commonly asked questions about all-laser LASIK with Intralase.  The best way to find out if you are a candidate for this vision correction procedure, is to come in for a free one-hour consult appointment.

LASIK vision correction is a 2-step process.

  1. First, we create the flap in the surface of the cornea.
  2.  Second, we lift the flap and apply laser treatment to reshape the corneal tissue.
What is Intralase?

Intralase flap creationA:   The IntraLase Method uses laser light to create a flap in the outer layer of your cornea.  The laser creates an even layer of microscopic bubbles under the corneal surface.  The flap is hinged, like the page of a book.  Dr. Moran then lifts the flap by gently separating the tissue where these bubbles have formed. After the flap is lifted, Dr. Moran moves to the second step of the procedure, applying the laser treatment to reshape the cornea.

What makes using Intralase technology unique?

A:  The IntraLase Method uses a laser to create the flap.  This laser-guided application creates a smooth even surface after your flap is lifted.

Are there benefits to using the Intralase Method?

A:  Although the risk of flap-related complications with LASIK is very low, with Intralase, the rate of flap complications are further reduced.  The flap created by the laser is determined and created by your surgeon, so it is tailored to the contours of your eye.

How long does LASIK surgery take?

A: The total time in the surgery suite takes about 20 minutes.  During step 1 of the procedure, creating the flap, the laser application takes about 15-20 seconds per eye.  Step 2 of the procedure, applying the laser treatment, depends on your prescription.  It can take from just a few seconds, to about one minute per eye.  Dr. Moran will  let you know the length of your specific treatment. During the laser application, he will count down the seconds, so you know how much time remains.  He keeps you informed about what you can expect, every step of the way.

What is the difference between LASIK and PRK (photorefractive keratectomy)?

A:  PRK vision correction is done without creating a flap.  Instead, PRK starts by removing a small area of tissue on the surface of the cornea.  A clear contact lens is placed on the eye after PRK surgery, to aid in comfort while healing.  Dr. Moran will remove the contact lens when the cornea is healed, usually about 3 days after surgery.  The recovery time for PRK is longer than LASIK. With LASIK you should be able to drive the day after surgery, while after PRK surgery, you may not see clearly enough to drive for a few days.  Why do patients choose PRK?  PRK is an option for patients who may not be able to have LASIK due to thinner corneas.  PRK is also preferred for patients who are at risk for eye injuries, including patients who do boxing, mixed martial arts, or who are joining certain levels of the military.

Ready for your  LASIK Consult?  Fill out the form, give us a call, or send a text, to get started on your way to better vision with LASIK.

 

 

 

 

You should not wear perfume to your LASIK procedure

Perfume particles in airThere is a lot to think about before getting LASIK surgery, and smelling nice isn’t usually at the top of the list. Smell and sight are too different senses right? What does one have to do with the other? Well here’s why as part of your pre-op LASIK instructions you will be told not to wear perfume or cologne.

LASIK surgery is a very precise and controlled surgery. While we can’t control how your eye will respond to the treatment, we can make accurate predictions. We can control how the laser is programmed and how the treatment is delivered. And we do control those things very precisely. We deal in microns. A micron is a millionth of a meter. To give you an idea of the size of micron, your hair is about 50 microns. And anything smaller than 40 microns you can’t even see.

While we can’t control your eye’s response,  we can and do control other things. The air the laser passes through before it treats your eye is a factor. We monitor the temperature of the air, the humidity in the air and the purity of the air. The laser only passes about 12 inches through this air. But the laser we use is a short wavelength laser.  The laser “fixes” or treats the first thing it comes in contact with. It doesn’t penetrate substances well. When we calibrate our laser and design our treatment we take this passage through air into account.

Because the smells are actually particles in the air, perfume can change this air. If everyone wore exactly the same perfume and the same amount we could account for this in our treatment. But that’s impractical and it’s best to have just “clean” air which we have calibrated for.

Skipping the perfume the day of the surgery allows for a more accurate treatment and more predictable results. Enjoy some of the cleanest air you’ve every smelled during your surgery and save the perfume for after surgery.

LASIK Myths & Facts

 

Vision Requirements for PA Drivers

car key

What are the minimum vision requirements for driving?

So often we are asked “How well do you need to see to drive?”  The vision rules may vary from state to state, so it is important to check the specific requirements for the state where your license was issued.  The information below is an overview for Pennsylvania drivers.  For complete, up-to-date information, please visit Pennsylvania Department of Transportation.

Visual Acuity 

A visual acuity test is an eye exam that checks how well you see the details of a letter or symbol from a specific distance.  The standard for normal vision is 20/20.   If your vision is measured at 20/40 or 20/60, it means that your vision is worse than 20/20.  With 20/40 vision, you need to be at a distance of 20 feet in order to see what someone with normal vision can see at 40 feet.

  • In order to drive without corrective lenses, like glasses or contacts, you must have 20/70 or better vision during the day. Nighttime driving requires 20/40 or better vision.
  • If you need corrective lenses to reach the vision requirements, you must wear them at all times while driving.

Restricted License

eye chart

  • If your vision can only be corrected to 20/60 you may be able to get a license that restricts you to drive during the day only.
  • If your best vision is between 20/70 and 20/100, you may be eligible for a restricted license that would prohibit driving on freeways and highways.
  • Restricted licensees may need to pass a vision test yearly.

Vision in One Eye Only

People who have only one eye, or have vision in only one eye have additional requirements.  These requirements include 20/40 vision in the good eye.  The vehicle must be equipped with mirrors or cameras that allow the driver to see 200 feet to the rear.

Other Considerations

In order to drive, you must also meet field of vision requirements.  Your horizontal visual field must be 120 degrees wide in order to qualify for a drivers license. Your visual field is measured by how well you see in your peripheral vision, while your eyes are focused forward.

If you drive professionally – like a school bus driver –  the requirements are more stringent.  The field of vision must be 160 degrees, and you must be able to identify colors used in traffic signals and signs: red, green and amber; and you must see 20/40 or better.

 

 

 

Surfer’s Eye

There is an eye condition called “Surfer’s Eye”.  Can you guess how it got its name?

surfing large

 

It’s not about the water…but If you thought it had to do with too much sun exposure, you would be right!

Long-term exposure to UV rays from the sun, as well as wind and dust, may result in growths on the surface of the eye.  Surfers are particularly vulnerable, since they spend their time in the sun without sunglasses or other eye protection.

The technical term for growths on the eye caused by sun exposure are called Pinguecula and Pterygium.  The condition appears on the eye’s conjuctiva (the clear covering over the white part of the eye.

pinguecula surfers eyePinguecula is a yellowish, raised growth on the conjunctiva. It’s usually on the side of the eye near your nose, but can happen on the other side too. A pinguecula is an abnormality formed by protein deposits, calcium or fat. It’s like a callus on your finger or toe.

 

Pterygium surfers eye

Pterygium (Surfer’s Eye) is a growth of fleshy tissue (has blood vessels). It usually has a triangular shape.  It can remain small or grow large enough to cover part of the cornea.  When it grows into the cornea, it can interfere with your vision.

Symptoms

The symptoms of pinguecula and pterygium can range from mild to severe. They include:

  • redness and swelling of the conjunctiva
  • a yellow spot or bump that builds on the white of your eye
  • dryness, itching and burning in the eye.
  • sensation of something in the eye

    Treatment

  • The best treatment is prevention…keep your eyes lubricated with artificial tears and wear sunglasses with UV protection.
  • If you have the condition, lubricating eye drops will help to reduce discomfort.
  • Your doctor can prescribe steroid eye drops which may reduce inflammation, redness and swelling in the eye.
  • Surgical Removal:  If eye drops alone don’t alleviate the symptoms, or if the growth is large enough to interfere with your vision, the growth can be removed surgically.

Protect your eyes, protect your vision.  If you have any questions about caring for your sight, email, call or text our office.  We are here to help!

 

 

Drops or reading glasses?

Woman reading paper

Most everyone has heard of nearsightedness and farsightedness, but, presbyopia isn’t quite as familiar to most people.

Remember nearsighted is when you can’t see in the distance. And, farsighted is when you can’t see up close. Both of these problems are due to the incorrect length of your eye so the image doesn’t land in the correct spot on your retina.

Presbyopia starts when you are about 40 years old.  It is when you have difficulty seeing up close.  What makes it different than farsightedness is the reason for the problem. Presbyopia is because the lens of your eye can no longer focus enough to place the images on the correct spot  of your retina.

Presbyopia develops because of the process of aging. Think of it as farsightedness brought on by aging. The root of the word “presbyopia” actually means “old eyes” in Greek. Everyone gets presbyopia. You can circumvent the need for glasses to focus up close, if you’re nearsighted.  Taking off your glasses “resets” your eyes to near and you don’t need to focus.

Refractive surgery such as LASIK effectively corrects nearsightedness and farsightedness by reshaping the cornea.  It does not treat the lens, and in turn doesn’t correct presbyopia. LASIK surgery can help presbyopia vision by leaving a small amount of nearsightedness, similar to the trick of a nearsighted person taking off their glasses to read.

Eye drops instead of reading glasses?

Recently two kinds of eye drops are being tested to enter the market to help presbyopia. If these drops pass clinical trials patients may be reaching for drops instead of reading glasses. As with any type of treatment or medication there are pluses and minuses.  Not needing glasses to read is the obvious plus.

The first type of drop being tested is called a miotic drop. It makes the size of the pupil smaller creating a “pinhole effect.” This effect limits the out-of-focus light entering the eye, making both near and far things clearer. Headaches, limited night vision and a decrease in contrast have been reported as side effects. The drops take effect  30 minutes after administration and last four to seven hours.

The second type of drop softens the lens of the eye. As the lens becomes more flexible, as it was in the younger eye, it becomes easier to focus up close again. The drop won’t return the lens back to its peak at eighteen years of age, but it will turn the clock back ten years. The drops must be taken over a period of days or weeks to achieve results.

We’ll keep you posted

Neither of these drops are available to the general public at this time. Neither drop appear to be the “magic bullet”  in treating presbyopia. Your eye doctor will likely need to determine which, if  any, is correct for you.

Read more about LASIK & Presbyopia  

 

 

 

What is an Astigmatism?

Do you have an astigmatism?

The word might sound scary, but an astigmatism is nothing to be afraid of!  It is a common vision condition which most commonly occurs when the cornea (the clear front cover of the eye) is irregularly shaped.

If you have an astigmatism, the curve of your cornea is shaped more like a football, instead of round like a basketball.  This irregular curvature causes vision to be blurry, because your eye cannot focus light to a single sharp point on the retina.  Instead, light hits the retina in multiple places, so images are blurred.

You may have been born with astigmatism.  You could have inherited it from your parents.   It can decrease or increase over time. Astigmatism often occurs along with with nearsightedness, or farsightedness.

How is astigmatism measured?

Astigmatism refraction

Testing for astigmatism may may include:

  • Visual acuity-When you read letters on a distance chart, you are measuring your visual acuity. The result is given in two numbers, like 20/40.  The first number is the number of feet from the eye chart. The bottom number shows the smallest size line you can read.  If you have 20/40 vision, you would have to be within 20 feet of the chart to see what someone with normal vision could see at 40 feet.
  • Topography– This device measures the topography of the surface of the cornea.  As you might guess, this measurement is important for a good fit for contact lenses.
  • Refraction– You might know this as the “Better 1 or Better 2 test”.  While you look through an instrument called a phoropter, we rotate through a series of lenses.  Based on your answers, the power is then refined to determine the lenses for the clearest vision. This power can be determined with machines but patient input remains integral in determining vision needs.

How is Astigmatism Corrected?

A comprehensive eye exam will measure the correction or power needed for your vision, which may include a prescription to correct your astigmatism.  Eyeglasses or contact lenses will help you to focus and to see more clearly.

  • Eyeglasses. Astigmatism can be treated with a pair of prescription eyeglasses.  The lens will have a prescription that compensates for the astigmatism. This prescription provides additional power in specific parts of the lens.  The correction power lies along a specific axis.
  • Contact lenses.  Contact lenses may provide clearer vision and a wider field of view.  A special toric soft contact lens offers astigmatism correction for many patients. This contact lens is weighted so that it maintains the correct axis when worn. Another contact lens option is a rigid gas-permeable (RGP or “hard”) contact lenses to help reshape the cornea decreasing the astigmatism.
  • Laser and other refractive surgery procedures. LASIK or PRK surgery can correct astigmatism by reshaping the cornea.  With LASIK using Custom-Vue Wavescan, your  treatment is tailored to your eyes.  Dr. Moran has great success treating patients with astigmatism.

Let us help you achieve your best vision.  Schedule an appointment to correct your vision.  Click here for more information on LASIK

How Does LASIK Work?

How the laser works to improve your vision during LASIK surgery.

LASIK vision correction uses a laser to reshape your cornea to help you see better.  To apply the laser treatment, Dr. Moran uses an excimer laser which emits a cool beam of ultraviolet light to precisely remove corneal tissue.  The reshaped cornea allows for light rays to focus properly on the retina to give you clearer vision.  

open book Think of the cornea as a closed book with 500 pages.  We create the flap about 100 pages into the book. Once the flap is opened, we apply the laser treatment to correct your vision in the last 400 pages of the book.

After your flap is lifted, the excimer laser applies pulses of ultraviolet across the cornea in a custom pattern designed for your eyes.  These precise light rays are able to remove as little as 0.25 microns of tissue at a time. How small is a micron?  One micron is a thousandth of a millimeter.

How the cornea changeS DUring LASIK

The laser treats your cornea to give you better vision.  Your cornea may be too long, too flat, or irregularly shaped.

  • If you are nearsighted, the laser will make the cornea more flat;
  • if you are farsighted, the laser will make the center of the cornea steeper.  
  • If you have an astigmatism, the laser will smooth your corneal tissue into a more symmetrical shape. 
  • If you have a combination of issues, the laser can treat  nearsightedness with astigmatism, as well as farsightedness with astigmatism.
How the treatment is determinedCustom vue

In order to create your treatment plan, Dr. Moran does careful calculations using the data from your pre-operative testing. He takes into account your age and your visual needs. Then, the laser is programmed with your unique measurements.  Once programmed, the laser is controlled by computer settings programmed to correct your specific refractive error.  We use Custom-Vue Wavescan technology.  It is called “Custom-Vue” since the pattern of treatment is customized for each patient to give you the best possible vision. 

Dr. Moran will ask you to focus on a light while the laser is being applied.  While it is important to keep your eye focused during the treatment, the laser has an added safety feature. The laser uses an eye-tracking system that monitors any eye movements and keeps the laser beam on target during surgery. Studies have shown that eye trackers produce better outcomes and decrease complications.  If your eye moves during the surgery, the laser will stay centered.  It will track and follow your eye movements. 

What to expect After LASIK

Post Op LASIK patientWhen the laser treatment is done, you will notice clearer vision than when you entered the room.  However, your vision will still be a little blurry – similar to seeing under water. The blurriness is because you have a lot of drops in your eyes!  Dr. Moran will have you sit up and look across the room at a clock about 10 feet away.  You will be able to tell him what time it is, even if you weren’t able to see the clock when you walked into the room. Your surgery day instructions are to go home and keep your eyes closed for the rest of the day.  Your vision will fluctuate as your eyes are healing, however, the next day you can drive to the office for your 1-day PO LASIK appointment.

 

To see if LASIK is right for you, schedule your FREE Consult today.  Call, email or text our office for your appointment.  Learn more about, just click LASIK