COA Vision Blog

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June 30, 2020 Cataracts

As Cataract Awareness Month comes to a close, we sat down to talk with COA’s Director of Glaucoma Dr. Robert Derick to ask him about how glaucoma and cataracts can be treated simultaneously. 

Dr. Derick, how many patients have a cataract and glaucoma?

Of the 4 million cataract surgeries performed annually in the US, more than one million of those patients are on one or more medications to control their eye pressure. Comorbidity is quite common.

Do patients that use glaucoma eye drops continue to use them after cataract surgery?

Most patients will experience some reduction of their eye pressure after cataract surgery. If the glaucoma is quite mild, this reduction may be enough to eliminate the need for drops. In patients with moderate-to-severe glaucoma, an additional procedure at the time of cataract surgery is generally needed to allow for a safe reduction or elimination of glaucoma medications.

What is this additional procedure that helps glaucoma during cataract surgery?

There are several options. For patients with mild-to-moderate glaucoma, there are procedures in the minimally invasive glaucoma surgeries (MIGS) category that can safely lower eye pressure. These are generally performed through the small incision we use for cataract surgery. They add little time or risk to the surgery and result in lower eye pressure and quick recoveries. Most of these involve micro-shunts that we place in the eye to enhance filtration of the aqueous humor, which is the fluid in the eye. 

We also have traditional glaucoma filtration surgeries that we have been performing for decades, and we can perform these in conjunction with cataract surgery for folks with more advanced disease.

How long would this surgery take? Are patients awake?

Cataract surgery with a MIGS procedure generally takes under 15 minutes. We perform the surgery with IV sedation and a local block. So patients are awake but are sedated and comfortable.

Can a glaucoma patient choose one of the special lenses to reduce the need for glasses after cataract surgery?

In many cases, yes. But we tailor the best lens for each patient on an individual basis.

What are some of the risks and potential complications associated with surgery for patients with glaucoma?

Like cataract surgery without glaucoma, the risks are fortunately quite low. We carefully monitor eye pressure, as patients with glaucoma can have wider variations in their eye pressure after cataract surgery. We can also adjust medications appropriately.

After surgery, how often will I need to be seen in the office?

Generally, patients will need to be seen the day after, week after, and month after cataract surgery with a MIGS procedure. This timeline is very similar to the timeline of patients who only need cataract surgery.


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Dr. Hoepf joined Columbus Ophthalmology Associates in 2014, where she practiced alongside our glaucoma specialist, Dr. Derick, for the first two years. She provides primary eye care to patients of all ages and continues to treat a wide range of ocular diseases. Dr. Hoepf also has a particular interest in the pediatric population. She has experience working with children of all ages in the treatment of common refractive and binocular disorders. She attended Ohio State University for her undergrad and lived in Boston for seven years, where she completed her optometric training as well as her residency.

In her life, she was no stranger to eye doctors, “I had to see an eye specialist from the time I was two years old, so eye doctors were a part of my life. I always wanted to help other people see better.” In her career, she continues to give back, “I have a passion for giving back to the profession by training students and residents, lecturing for continuing education.  I love to be in an environment where I can collaborate with other doctors in the multi-specialty practice. COA provides an opportunity to care for a diverse population and allows me to utilize my experience in ocular disease.”

Her dedication to her career and charity does not fall short in her list of achievements. Dr. Heopf was involved in research during optometry school, where she performed laboratory studies with and utilized imaging equipment at Harvard. She has published papers in academic journals and lectured at local and national meetings. She has also volunteered for a mission trip in Nicaragua and hopes to be involved with more organizations in the future to continue similar work. This past summer Hoepf was inducted into the American Optometric Association and continues to be an active member of the American Academy of Optometry.

In her free time, she enjoys traveling, running, camping, hiking, and skiing. She actively involves her family in her charity work, “I have three beautiful children, and we enjoy volunteering for an organization in Columbus. We deliver Meals On Wheels, collect and donate clothes for homeless, make lunches and compassion kits for homeless and underserved populations as well as many other service and community building activities.”

We are thrilled to have Dr. Hoepf as a part of the COA family. In the coming month, she will begin seeing patients as part of the glaucoma team. We know she is going to deliver the outstanding care that patients expect to see from Columbus Ophthalmology.

 



January 10, 2020 Eye care

We have all either heard someone or ourselves brag that we have “20/20 vision”. But what does that exactly mean? And is it an accurate indicator of “perfect” vision?

That 20/20 number is a term used to represent normal or ‘perfect’ vision. This number measures visual acuity, which is the clarity or sharpness of your vision measured at a distance of 20ft. So if you have 20/20 vision, you can see at 20ft what someone with perfect vision can see at that distance. If someone has less than average vison, say 20/70, what they see at 20ft is what a person with perfect vision can see at 70ft. While visual acuity is a good measure of the sharpness and clarity of your vision, it does not take into consideration other fundamental aspects of vision. Visual acuity is also not the determining factor in your overall eye health.

If you’ve seen an eye doctor, your visual acuity was tested using the “big letter poster” or Snellen chart. A Dutch ophthalmologist developed the chart in the 1800s. The sizes of the letters are precisely calculated to adhere to the standard of the 20/20 scale. The letters are also carefully chosen. You may have noticed that the only letters used are C, D, E, F, L, N, O, P, T, and Z. The reason behind these letter choices is that some letters can be distinguished even with blurry vision. For example, the letter Q’s tail can be recognized because there are no other letters like it. While the standard for this chart is 20/20 A.K.A “perfect” vision, some people can see better than 20/20 and are born with 20/15 or even 20/12 vision. These people have what is called “supernormal vision.” People who had LASIK surgery can usually see 20/20 or better, and people can be prescribed glasses or contact lenses that can help them see 20/20 (or better).

The Snellen chart is an excellent indicator for your eye doctor to determine if you need glasses or contacts. However, this is not the only test you should be given during a comprehensive eye exam. While vision and focus are critical, overall eye health is also essential. Good focus and good eye health do not always go hand in hand. Vision traits that contribute to your overall visual ability include your peripheral vision or side vision, eye coordination, depth perception, focusing ability, and color appreciation. Even if you have excellent vision, you should go for an eye exam once every year or two years. Eye doctors are also looking for your risk of eye diseases such as cataracts or glaucoma. If you have any pre-existing medical conditions, this could also impact your vision as well.  Besides, focus is not static through a lifetime, and changes are bound to happen to everyone.

So the next time you hear friends or family say they have 20/20 vision and don’t need their eyes checked, be sure to inform them there is a lot more to vision than they think.



October 16, 2019 Eye careHealthcarePeople

Our measure of success at Columbus Ophthalmology Associates is how satisfied our patients are with their experience.  Our goal is to improve the lives of people in our community by improving their vision.  For many, poor vision hinders their ability to accomplish goals, and enjoy life. Recently, we have had 3 patients whose lives were changed by surgeries received by two of our doctors at COA, these are their stories.

William Ernst: Cataract Surgery

William said that his biggest complaint was not being comfortable driving, at night is when it became particularly worse because of distracting halos he would see around other lights. This made it nearly impossible to clearly see the road. Once he had enough, his optometrist referred him to Dr. McHale. William said “I liked Dr. McHale the moment I came into the office. Mr. Ernst described his procedure as “so relaxing” and “painless”. When asked what he expected out of the surgery he stated ” I was very reassured with the entire procedure, I’ve always had sensitive eyes so I was nervous it might be painful but talking to Dr. McHale reassured me that I had nothing to worry about. I told Dr. McHale I did not want to wear glasses after the surgery, so he recommended that we do mono vision. My one eye is in focus in the distance while the other eye can see up close and I never wear glasses the procedure went better than I could have ever expected. If I had to do any surgery again I would choose cataract surgery with Dr. McHale.”

Robert E. Hockenberger: Cataract Surgery with iStent for Glaucoma

Robert recently had cataract surgery with an iStent put into his eye for glaucoma treatment. The iStent is a relatively new minimally invasive glaucoma surgery designed for patients with mild to moderate glaucoma to help reduce the need for glaucoma drops. After being on glaucoma eye drops for over 5 years, he came to COA through a referral from his optometrist, “They told me, you have to go see the best surgeon for this, and that’s exactly what I did.” Robert mentioned that he could only see with his glasses and was getting tired of never seeing with full clarity. “To me, the television never had a clear picture and now I can see every hair on someone’s eyebrow,” he remarked. Mr. Hockenberger didn’t really know what to expect during the surgery but said overall it took about 10 minutes, it was painless and he was surprised by how quick the aftercare process was. In addition, he no longer requires medications for his glaucoma. His advice, “If you need the surgery, get it done and do it with Dr. Derick because not only will he do it right, he will listen to your bad jokes along the way.”

Kenneth Puterbaugh: Cataract Surgery and Hydrus Micro Stent for Glaucoma

Kenneth met Dr. Derick through his auto body repair business and was complaining about tension in his eyes causing headaches. When he came to COA Mr. Puterbaugh had nothing but kind words about the staff and the care he received. “Overall, it was a positive experience; I could not believe the incredible bedside manner I got from Dr. Derick and the rest of the staff.” He had cataract surgery along with implantation of the hydrus implant to help treat his glaucoma. The Hydrus, like the iStent , is a minimally invasive glaucoma surgery designed to treat patients with mild to moderate glaucoma.  Kenneth’s passion is art, he works with oils, watercolors, and sculpting, but as an artist with vision problems, he felt like he wasn’t at his best. “Being an artist, I want perfect vision. After my surgery, I now know that an eye doctor is an artist’s best friend.” Mr. Puterbaugh had his doubts when it came time for surgery, he stated: “I expected surgery of the eyes to be uncomfortable and not pleasant, but I was shocked on how simple and painless it all was, that’s why I told Dr. Derick I want to be your poster child for this!” Kenneth mentioned the healing process was quicker than he expected, he stated: “I would tell everyone you will only be inconvenienced for a day or two after surgery, but it will heal before you know it.” He now enjoys 20/20 vision is glaucoma medication free and is back to his painting and sculpting like never before.

 

Good patient experiences like this are why we come to work with excitement and purpose every day at Columbus Ophthalmology Associates.  We are humbled to be a part of each and every patient’s success story.


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Blinking is essential. Every time our eyelids close, salty secretions from our tear glands sweep over our eyes’ surfaces, protecting them from harmful particles. The average person blinks 12 to 15 times per minute but when you’re in front of a computer screen, that number decreases dramatically to 3 to 4 times per minute. With the average American spending 6 to 8 hours each day in front of a computer, we’re missing out on hundreds of opportunities to cleanse and protect our eyes.


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June 21, 2019 CataractsEye care

Diabetes is a disease that affects the amount of sugar in the blood, and can also cause cataracts. Cataracts cloud the eye’s naturally clear lens, and diabetics are more likely to develop this condition that impairs your vision. Columbus Ophthalmology Associates specializes in eye care for patients with diabetes, and the following video with Dr. McHale shows how we can help restore your eyesight through cataract surgery.


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June 14, 2019 Eye care

With the talk of cannabis constantly growing, we get a number of patients who ask about marijuana and glaucoma. We would like to shed some light on the reality of the situation and have asked Dr. Orlando, founder of Columbus Ophthalmology Associates and expert cataract surgeon to shed some light on the reality of using marijuana to treat glaucoma.

But first, let’s start with what is glaucoma?

Glaucoma is a common sight-threatening disease that can cause damage to the optic nerve damage, the delicate cable-like structure that connects the eye to the brain. Most often, the damage is a result of chronic high pressure within the eye that slowly destroys the nerve fibers from the inside of the nerve outward. The loss of optic nerve fibers is not reversible but at detection and with treatment, the progression of the disease can be stopped.

 

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Now that we’re clear about glaucoma, we’ve asked Dr. Orlando to give us a glimpse of what he shares with his patients about glaucoma and the use of cannabis.

“Last year Ohio voted to legalize medical marijuana and almost immediately patients began to ask if it would help them with their glaucoma. So far, Ohio has not determined what medical conditions and in what clinical circumstance cannabis can be used. However, the drug has been studied for many years by ophthalmologists as public opinion has more or less approved it’s use for glaucoma. But the scientific reality is that it does not really work as treatment for this potentially blinding disorder. First of all, one must understand that glaucoma is a very multi-faceted and challenging disease that can present in a variety of ways. Basically, the internal pressure of the eye damages the delicate optic nerve which connects the eye to the brain where images are created. Eye doctors measure this pressure as part of their routine eye exam and look for elevation that is above the normal of 20mmHg. However, damage can occur even with pressure readings lower than 20 and so the optic nerve itself needs evaluation with a variety of tests that can pick up early signs of damage. When diagnosed, the glaucoma specialist will set a “target pressure” and begin the most appropriate treatment to lower the readings to that point. Follow up visits are required in order to make sure there is no further damage to the nerve with the initial medical therapy. In some cases, a special laser known as the SLT will open the internal canals and allow the pressure to drop if topical drops do not control the pressure readings at a safe level. In extreme cases, microsurgery will create a drain from inside to drop the pressure and prevent further damage.

Scientific research on the use of cannabis for glaucoma treatment has been done for over 30 years. Initial studies done with patients smoking the drug found pressure readings that dropped around 25% but the effect lasted only 2 to 4 hours. Other studies with oral administration of cannabis extract also showed only a short time frame for lowering of the intra-ocular pressures. Some case reports have showed variable response to the drug in lowering pressures and so the overall consensus is that cannabis is ineffective for long term treatment of glaucoma. There are far more proven effective therapies and the American Glaucoma Society has stated there is no form of cannabis that is recommended for treatment of this disease.  The University of Mississippi is currently the only approved site for cannabis research and we will await further studies to see if this can be an effective adjunct to our current treatment options.”

Hopefully this update from Dr. Orlando has helped shed some light on the use of cannabis for the treatment of glaucoma. If you are suffering from glaucoma and would like to speak with a specialist, please call our offices and we will be happy to assist you.


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June 7, 2019 Eye care

A number of our patients come to see us because they need to discuss next steps towards getting rid of their cataract. We realize that some people are nervous by this conversation but it’s nothing to fear. We want to ensure that you and your family are fully confident in knowing what a cataract is, how common it is, and how quickly we can help you get rid of it and begin enjoying your life with great sight!

What is a Cataract?

Everyone has a natural lens in both of their eyes. Cataracts form in the actual lens – not on top or underneath it. “I see a number of patients that think a cataract is something that is laying on top of their lens, as if we can simply go in and remove the covering. It doesn’t exactly work that way, but the actual procedure isn’t much more complicated. It’s so simple, the procedure of removing and replacing the lens is completed in 10 or 15 minutes” said Dr. James McHale, an Ophthalmologist and Managing Partner at Columbus Ophthalmology Associates who says he completes this procedure hundreds of times a year. Like Dr. McHale said, a cataract is when the lens, which is clear most of your life, becomes cloudy. At a point, that cloudiness can cause blurry or foggy vision, problems with glare from headlights or the sun, a dullness in color, and other issues. See photo below of what someone with normal vision versus someone with a cataract would see if they looked at the same photo:

Cataract before and after

 

How do you treat Cataracts?

Removal and replacement of the cloudy lens with an Intra-Ocular Lens is the only way to treat a cataract. But don’t worry, it’s not a difficult procedure at all! Cataract surgery is one of the most successful operations in all of medicine and it has excellent results. The actual procedure only takes up to 15 minutes – and there are no sutures to deal with. Your healing time is quick and most people resume normal activities in days! Cataract surgery is such a common procedure, that by the age of 80, half of all Americans have a cataract or have had cataract surgery. So if you have to have this procedure, we don’t want you to worry at all! We’re here to help you through it.

If you would like more information on Cataract Surgery, watch this quick video:
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If you are struggling with cataracts and this is a treatment you need to have, hopefully this will encourage you to further look into completing your cataract surgery. Remember, you are always free to call our office and speak with someone to ask questions and to schedule an appointment to see one of our Ophthalmologists. We would be happy to see you and discuss your options for a brighter, and clearer, vision future!


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May 31, 2019 Eye care

Springtime is here and along with the warm weather we all patiently waited for comes seasonal allergies. According to the CDC, over 50 million Americans will suffer from allergies this year. Seasonal allergies can cause a variety of unpleasant symptoms including, sneezing, sinus congestion, itchy throat, and eye irritation. With the pollen count around Columbus, OH averaging in the medium to high zone (5.3-12 )* for the past month, our doctors at COA have been seeing an influx of patients that have irritation, itching, and redness around the eyes. Find out how you can help protect your eyes from seasonal allergies and when to see a doctor for major eye issues that could easily be masked by allergies.




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