EDUCATION

Cataracta. The advances in cataract surgery over the last few decades are the envy of medicine. Ophthalmic surgeons have more options than ever before. Patients can now choose surgery designed to reduce or eliminate the need for glasses. Close to four million cataract surgeries were performed in the United States alone last year, and the vast majority provide dramatic improvements in vision and quality of life for patients.b. Treatment options we offer:  c. Cataract surgery    i. Cataracts are a cloudiness that develops slowly inside the eyes. When the cloudiness is too distracting for day-to-day activities, surgery can be done to remove the cloudiness from the eyes. Surgery is performed in a surgery center or hospital; Dr. Esposito operates at Summa Hospital in Medina. You will be able to return home the same day. A medical-grade lens implant replaces the cataract, which is measured for your eye’s prescription. After cataract surgery, your vision will be greatly improved. d. YAG capsulotomy    i. Roughly 30% of patients will develop a second “cataract,” or a film, on the implanted lens. Thankfully, the procedure to remove this film is very straightforward and can be performed in the office. A laser procedure is used to remove the second cataract. 
Dry Eyea. Dry eye is a disease of the eyes and tends to fluctuate chronically. Normally, a robust tear film protects the eyes and maintains a smooth surface for the best vision. If the tear film is poor quality or low in quantity, vision will likely blur, and the eyes tend to feel uncomfortable. Scratchiness, irritation, fatigue, and discomfort are hallmark symptoms of dry eye. Infection or inflammation of the eyelids can also contribute to dry eye disease. Dysfunction of the oil glands in the eyelid can cause dry eye disease to worsen as well. Other medical problems can predispose a patient to dry eye disease - problems such as acne, rosacea, or autoimmune problems like Lupus. Risk factors for dry eye disease include gender, genetics, age, occupation, and environmental exposure. A proper diagnosis is essential to provide effective treatment. b. Treatment options we offer:c. IPL i. IPL, or Intense Pulsed Light, uses directed light treatment to close the abnormal blood vessels under the skin around the eyes, which reduces inflammation and helps improve dry eye signs and symptoms.d. Lipiflow i. Heating and massaging treatment for the eyelids, which improves meibomian gland function and can reduce dry eye symptoms.e. Prescription Eye drops such as Restasis, Xiidra, Cequa, and Miebo i. Increases tear production and/or improves eye comfort. f. Autologous “serum” tears i. A sample of your blood is sent to a specialized lab to create lubricating drops from the ingredients of your own body. g. Amniotic membrane i. Amniotic membranes are created using material from the placenta, which has anti-inflammatory and anti-scarring properties. These ingredients can tremendously help heal the surface of an eye with tissue damage from dry eye disease.
Professional Organization Sites For The PublicThe American Academy of Ophthalmology and the American Optometric Association are the leading organizations representing the vision care profession. Drs. Noreika and Esposito are members of the American Academy of Ophthalmology; Dr. Wiseman is a member of the American Optometric Association. These websites are an starting place for trustworthy internet information on eye health.
EyeSmart: American Academy of Ophthalmologyhttp://www.geteyesmart.org/eyesmart/diseases/index.cfm
American Optometric Associationhttp://www.aoa.org/patients-and-public/eye-and-vision-problems/glossary-of-eye-and-vision-conditions
Glaucomaa. Glaucoma is described as the “Silent Thief of Sight.” It is one of the leading causes of vision loss. Glaucoma is a condition that damages the optic nerve, which is the structure that connects the eye to the brain. Typically, the damage accumulates slowly and does not cause any eye pain, so patients do not notice a difference in their vision until glaucoma is very severe. A comprehensive eye examination is necessary to find signs of glaucoma early on. If your eye care provider determines you are at risk for glaucoma or that glaucoma is occurring, they can discuss what therapy is best to preserve the optic nerve’s function. Glaucoma causes peripheral vision loss, and with progression, it can cause permanent blindness. However, with modern medicine, the majority of patients do not go blind. The key is early diagnosis and using treatment to prevent optic nerve damage. Treatment is currently centered around managing the pressure of the eye. By maintaining steady eye pressure, the optic nerve tissue can be preserved and prevent vision loss for the patient. b. Treatment options we offer: c. Prescription drops    i. Medicine is designed to lower the eye pressure. One category of these medications increases how much fluid the eye processes out, which helps lower eye pressure. Another category of medicine works to reduce how much fluid the eye produces overall, thereby lowering eye pressure. d. Prescription medication implant    i. Medicine designed to lower the eye pressure has been formed into an implant that is injected into the front of the eye. This procedure is done in the office. This allows the medicine to slowly dissipate in the eye, having a long-lasting effect on maintaining the eye pressure. e. SLT and LPI    i. Laser procedure that opens the angle of the eye to allow better fluid drainage, which helps manage the eye pressure. This procedure is performed in the office. f. Hydrus microstent    i. Small tunnel of scaffolding is placed at the angle of the eye to allow better fluid drainage. This helps manage eye pressure. This procedure is done while you have cataract surgery. g. Exam Testing:h. OCT    i. This specialty machine scans the optic nerve tissue and compares the data of your eye to other patients with normal tissue. Over time, your eye care provider will compare your baseline scan to current scans; this allows for subtle changes of the tissue to be caught early, which allows better management of glaucoma. i. Visual Field     i. This specialty machine tests your peripheral vision, or side of your vision, which allows your eye care provider to monitor for subtle changes that you may not notice day to day. Your doctor’s goal is to minimize any vision loss occurring from glaucoma. 

Macular Degenerationa. Macular degeneration is a problem that affects the macula, which is responsible for the center of your vision. In macular degeneration, the tissue of the macula deteriorates over time. Slowly, the eye’s most acute vision used for reading and detailed work can fade. We are able to monitor for changes in your condition with dilated eye exams and specialty testing. New therapeutic options and further research continue to evolve the options for this condition. There are two types of macular degeneration: dry macular degeneration and wet macular degeneration. The majority of patients have the dry form, which traditionally has been monitored. However, new medications have arrived to help manage severe dry macular degeneration. Wet macular degeneration is able to be treated by a retinal specialist to preserve vision; these treatments do not reverse vision back to normal, but help prevent extensive damage to the tissue, which helps prevent vision loss. Risk factors for macular degeneration include age and genetics; patients with a family history can take steps to reduce the risk of developing the disease with lifestyle changes. It is recommended to avoid smoking, as this is the highest risk factor for macular degeneration. Additional recommendations include a diet heavy with leafy greens and colorful vegetables, and wearing sunglasses with UV protection.b. Exam Testing:c. OCT    i. This specialty machine scans the macula and shows your eye care provider the eye’s tissue, layer by layer. This scan helps your eye care provider see very small changes today and compare the tissue’s integrity over time. d. Fundus photographs    i. This machine takes a picture of the inside of the eye. Different filters can be applied to assess the integrity of the eye’s tissue.

OtherThis is an interesting website that concentrates on conditions that greatly affect the quality of life of our elderly patients. The proposed connection of glaucoma to central nervous system degeneration is compelling. Research initiatives to prevent or repair the slow deterioration of the macula, your retina’s cells necessary for reading vision, is very exciting. More information on this subject may be found in Dr. Noreika’s blog.www.brightfocus.orgEmphasis on Alzheimer’s, Macular Degeneration and Glaucoma
Retinal DetachmentAlthough rare, retinal detachment is a serious threat to vision. It presents in all age groups but is most commonly seen in patients who are near-sighted, have had previous blunt injury to the eye, or have genetically determined conditions such as lattice degeneration. Many patients who develop retinal tears and detachments notice the sudden onset of sudden flashes of light and the appearance of more floaters in their field of vision. These symptoms should be evaluated at the earliest opportunity. Excellence in Eyecare sees patients work-in to the schedule every day.http://www.webmd.com/eye-health/eye-health-retinal-detachmenthttp://www.nlm.nih.gov/medlineplus/ency/article/001027.htm
Diabetes And The EyeDiabetes is epidemic in the United States. It is the leading cause of new blindness and is almost always treatable. New approaches suchas anti-VEGF injections are transforming the outcome of this serious disease. Diabetes is also associated with an increased incidence ofcataract and glaucoma. All patients with a diagnosis of diabetes are recommended to have an annual comprehensive eye examination by an ophthalmologist. Our protocol at EiE is to monitor patients with diabetes by supplementing our clinical exam by using the latest imaging technology.http://www.diabetes.org/living-with-diabetes/complications/eye-complications/http://www.nei.nih.gov/health/diabetic/retinopathy.asp
Floatersa. Usually more of a nuisance than a problem, floaters are a common symptom and complaint from patients. Floaters are inside the eye, in a part called the vitreous. The vitreous, which is like a pocket of fluid inside the eye, slowly degrades over time. As it degrades, more proteins separate and clump together, which can cause shadowing - this can be seen as floaters. This pocket of fluid typically degrades into a larger floater over time, called a posterior vitreous detachment. b. If you ever notice a change in floaters, especially a large number of them all at once or new floaters accompanied by flashes of light, you should be evaluated with a dilated eye exam within 24 hours of symptoms starting. Retinal detachments, though rare, are a serious threat to vision. It can present at any age. Risk factors include being near-sighted, previous eye injury, and genetics. Many patients who develop retinal tears and detachments notice a sudden onset of flashes of light, an increase in floaters, and/or a curtain covering part of their vision.c. Treatment we offer: i. YAG vitreolysis ii. Non-invasive treatment for a posterior vitreous detachment floater. Performed with a laser, this in-office procedure is fairly quick and can be very effective at breaking up the large, bothersome floater. Consult with Dr. Esposito to see if you are a good candidate!
Retinal or Ocular Migrainehttp://www.webmd.com/migraines-headaches/guide/ocular-migraine-basicsThere are several variations of migraine syndrome. The classic migraine syndrome preceded by an aura and resulting in a “sick” headache leading to bed rest in a dark, quiet room is most often referenced. Retinal migraines are thought to occur for the same reasons as do classic migraines. There is usually a family history. Episodes of fluttering light in the peripheral vision, blurriness extending to the center of vision, and difficulty focusing are hallmarks. The epidodes typically last twenty minutes or less; headache is rare. Migraines become less common with advancing age. It is important to rule out other causes of vision disturbance.
Amblyopiaa. Amblyopia means the eye has reduced vision and develops in childhood. It can be caused by an eye turn or a prescription that is not corrected with glasses or contact lenses. b. It is important to monitor for amblyopia in young children in order to initiate treatment if needed. Studies show children older than 12 years of age typically do not have much improvement with amblyopia treatments. This means if a child is not treated early on, their vision will likely be reduced for their entire life. c. This condition can be treated in childhood with a few methods: d. Treatment options we offer:     i. Glasses        1. Some children will completely resolve amblyopia by wearing glasses full time. The brain is able to use the corrected vision and “pay attention” to the eye with the higher prescription.     ii. Atropine         1. Strong dilating drop that prevents the eye from focusing. Atropine is used in the better-seeing eye to allow the brain to focus on the eye with worse vision. It is important to still wear glasses full time or contact lenses as directed.     iii. Patching         1. Covering the better-seeing eye allows the brain to focus on the eye with worse vision. It is important to patch while the child is wearing glasses or contact lenses, if they have been prescribed. 
Myopiaa. Myopia is near-sightedness, which means far-away objects are blurry. This condition can be improved by using glasses or contact lenses to improve vision at a distance. Typically, every year, patients with myopia need a stronger prescription; this is due to the eye growing faster than the “average” eye. Research has shown that children can be treated to potentially prevent an increase in the prescription over time. b. Treatment options we offer: c. Low-dose Atropine     i. Atropine at full strength is a powerful dilation drop. However, research has shown that when atropine is diluted, there are very minimal side effects. Yet the small amount of atropine medicine can have a positive effect on the eye - it can slow the growth of the eye. This slowed growth can reduce the progression of myopia. d. MiSight contact lenses    i. These new contact lenses are FDA-approved to slow the progression of myopia. Their special design signals the eye to grow slowly, which helps slow myopia progression. 
Diabetic retinopathy a. Diabetes is an epidemic in the United States. This disease affects the entire body, including the eyes. Diabetes is a risk factor for developing certain eye conditions, such as cataracts and glaucoma. All patients with diabetes are recommended to have an annual dilated eye examination to monitor for changes. Diabetes is the leading cause of new blindness, especially in working-age adults. The cause of vision loss is due to leaking fluid and bleeding inside the retina - this is called diabetic retinopathy. We can monitor mild and moderate diabetic retinopathy in our office. New medications and procedures are able to treat severe diabetic retinopathy and prevent vision loss; these are performed by a retina specialist. 
LASIK evaluation and post-op care
a. Interested in correcting your vision surgically? Our eye care providers are able to evaluate your prescription and ocular health, and help educate you on the benefits of procedures like LASIK. If you are a good candidate, we are able to coordinate care for follow-up appointments. 
Ocular Migraine
a. There are several variations of migraines. The classic migraine syndrome, preceded by a visual aura and resulting in a severe headache, which leads to bed rest, is the most common. Typically, patients have a family history of migraines in this scenario. Ocular migraines are thought to occur for the same reasons as classic migraines. There is usually a family history. Episodes of fluttering or zig-zagging light in the vision, blurriness extending to the center of vision, and difficulty focusing are hallmark symptoms. The episodes usually last twenty minutes or less; headaches rarely occur afterwards. Migraines become less common with increased age. It is important to rule out other causes of visual disturbances.