SERVICES

When an ophthalmologist examines your eyes, he or she is doing more than checking to see if you need glasses. During a complete eye exam, your doctor will not only determine your prescription for glasses or contacts, but will also check your eyes for common eye diseases, make sure your eyes are working together and evaluate your eyes as an indicator of your overall health.

In addition to checking your vision, ophthalmologists also check for eye and other diseases that have no early symptoms, but should nevertheless be treated early. Vision screenings performed by the school nurse or your employer are not the same as comprehensive eye exams.

Regardless of age or physical health, it’s important for everyone to have regular eye exams. You should have your eyes tested to keep their prescriptions current and to check for early signs of eye disease. For children, eye exams can plan an important role in normal development. Vision is closely linked to the learning process. Children who have trouble seeing or interpreting what they see will often have trouble with schoolwork. Many times, children don’t complain of vision problems simply because they don’t know what normal vision looks like.

Dr. Richard Hoffman, Dr. Annette Chang Sims and Dr. Janet Lim specialize in cataract surgery, including femtosecond laser-assisted cataract surgery. Cataract surgery is very successful in restoring vision. In fact, it is the most frequently performed surgery in the United States, with over 1.5 million cataract surgeries done each year. Nine out of 10 people who have cataract surgery regain very good vision, somewhere between 20/20 and 20/40.

When the clouded lens of the eye is removed during cataract surgery, a replacement for the human lens is needed to restore focus to the eye. This implant is called an intraocular lens.

In clear corneal cataract surgery, as developed by I. Howard Fine, M.D., a tiny incision is made into the perimeter of the cornea on the side of the eye which is closest to the temple. This incision provides a corneal tunnel through which the cataract is removed and the intraocular lens is implanted. It is the architecture of this incision that makes it self-sealing, thus requiring no stitches.

Your physician will recommend cataract surgery when your cataracts have progressed enough to seriously impair your vision and affect your daily life. Many people consider poor vision an inevitable fact of aging, but cataract surgery is a simple, relatively painless procedure to regain vision.

The cornea is the clear, dome-shaped, front surface of our eye. Incredibly, it is composed of five layers of tissue. The cornea’s key role is to control and focus light entering into the eye. It also protects the eye from dirt, germs, ultraviolet light, and other matter.

If anything interferes with the cornea’s clarity or smoothness, light passing through it will become distorted, causing a hazy image and blurred eyesight. The cornea can heal itself from minor injuries and scratches. But moderate to severe damage can cause it to become swollen, scarred, cloudy (even opaque), or develop irregularities in the surface. Such damage can result from direct corneal trauma, such as being hit in the eye with a sharp object, or infection from bacteria, a virus, a fungus, or other organisms.

Dr. Richard Hoffman is one of the Pacific Northwest’s leading corneal specialists. Following completion of his medical degree and residency, he went on to complete highly specialized training in Cornea and External Diseases. He has extensive training and experience in corneal transplantation and excimer laser refractive surgery.

Problems treated include:

Corneal dystrophies (including Fuchs’, endothelial, anterior basement membrane and lattice dystrophies), keratoconus, herpes zoster, iridocorneal endothelial syndrome, pterygium, pinguecula, corneal scars, astigmatism, severe dryness.

Procedures and treatment include:

Corneal transplantation, DSAEK, DALK, DMEK, PKP, superficial keratectomy, lamellar keratectomy, corneal relaxing incisions, tarsorrhaphy, punctal plugs, bandage contact lenses, corneal cross-linking evaluation, additional corneal grafting after pterygium and pingueculas are removed (autologous graft, amniotic membrane graft).

Glaucoma is a term used to describe a group of diseases in which the pressure within the eye is increased, resulting in damage to the optic nerve. Glaucoma is a potentially blinding disease. It can be controlled with medication, but it cannot be cured.

Glaucoma is caused when the pressure in the eye (intraocular pressure, or IOP) increases to dangerous levels, damaging the optic nerve. This can result in decreased peripheral vision and eventually blindness.

Glaucoma has NO warning symptoms in its early stages. Early detection and treatment are key, as the prognosis can be good with medical or surgical treatment.

Dr. Annette Chang Sims serves the greater Eugene/Springfield areas and beyond as fellowship trained glaucoma specialist. Her expertise is in the diagnosis, medical management and surgical treatment of glaucoma. Dr. Sims performs advanced glaucoma procedures including multiple modalities of laser treatment and surgery. Some of these procedures include selective laser trabeculoplasty, trabeculectomy, iStent, Ahmed and Baerveldt shunt implantation, ExPress mini shunt implantation and transscleral cyclophotocoagulation.

Glaucoma Treatment

Glaucoma can be treated in a number of ways, including:

Medication – Medicine in the form of eyedrops is tried first to control the pressure in the eye.

Laser Surgery – There are several lasers that can be used based on the type of glaucoma being treated.

Conventional Surgery – If medications and laser treatment fail to bring glaucoma under control, glaucoma surgery may be indicated.

For millions of people, corrective eye surgery has dramatically changed the way they see the world. Driving, swimming, hiking, and even simply waking up in the morning becomes clearer – without glasses or contact lenses. 

iLasik eye surgery is suitable for treating nearsightedness, farsightedness and astigmatism. If you are not completely satisfied with contact lenses or glasses, refractive eye surgery may be an option to consider. Several factors are considered in determining candidacy for refractive surgery:

• Amount of refractive error (or necessary correction)
• Age of patient (at least 18 years of age)
• Stability of refractive error
• Health of eyes

Unlikely candidates are those under 18 years of age, a history of corneal surgery or scarring, or having sight in only one eye.

We know the decision to have corrective eye surgery is a big one, so we take great care to determine what’s best for you as our patient. We offer bladeless LASIK eye surgery using the IntraLase Bladeless LASIK Surgery (iLASIK) method. This bladeless, computer-guided technology is 100% more accurate than most of the mechanical microkeratomes (hand-held devices with a thin metal blade) that eye surgeons may also use to create a corneal flap. This method has been used successfully on hundreds of thousands of eyes and we trust this advanced technology to deliver exceptional results. Our commitment is to provide you with the ultimate in comfort, safety, and outstanding vision. iLASIK can help you achieve all of this, while delivering the added assurance of knowing you are being treated with the most advanced technology available.

We also offer PRK (photorefractive keratectomy), Refractive Lens Exchange and the Implantable Collamer Lens.

Choosing to undergo LASIK eye surgery is not a small decision. You can trust in Drs. Fine, Hoffman and Sims to conduct your LASIK eye surgery successfully.

Call us to set up your complimentary iLasik Consultation, 541-687-2110

iLASIK

We offer bladeless LASIK eye surgery using the IntraLase Bladeless LASIK Surgery (iLASIK) method. This bladeless, computer-guided technology is 100% more accurate than most of the mechanical microkeratomes (hand-held devices with a thin metal blade) that eye surgeons may also use to create a corneal flap. This method has been used successfully on hundreds of thousands of eyes and we trust this advanced technology to deliver exceptional results. Our commitment is to provide you with the ultimate in comfort, safety, and outstanding vision. iLASIK can help you achieve all of this, while delivering the added assurance of knowing you are being treated with the most advanced technology available.

PRK

PRK, which stands for photorefractive keratectomy (photo means “light,” kerat- means “cornea,” -ectomy means “cutting”). The procedure is done with an excimer laser, to change the curvature of the cornea. The difference between the PRK and iLASIK is that with PRK, the laser reshapes the outside surface of the cornea, while with iLASIK a thin flap of corneal tissue is created then gently folded back after the laser procedure is complete.

After surgery, a “bandage” contact lens will be placed on your eye, and the eye will be covered by a clear protective eye shield. You will need to wear the contact lens until the corneal surface heals, usually 3-4 days. At that point, you should notice an improvement in vision, which should get even better over the following weeks.

The best candidates for PRK eye surgery have mild to moderate nearsightedness, farsightedness, and/or astigmatism. PRK refractive surgery is also suitable for higher prescriptions. You must be over the age of 18, in good healthy physically and have healthy corneas.

Implantable Collamer Lens

The Implantable Collamer Lens (ICL) is an intraocular lens implant designed for correction of moderate to high nearsightedness or farsightedness. The ICL is designed to be permanently implanted inside the eye behind the iris (colored portion of the eye) but resting in front of the natural crystalline lens. The lens cannot be felt inside the eye and does not require maintenance.

The best candidates for ICL surgery have moderate to high nearsightedness or farsightedness, are over the age of 21 and in good health physically.

Refractive Lens Exchange

Refractive Lens Exchange (RLE) is gaining popularity as a surgical option for people over 50 who want to decrease or eliminate their dependence on glasses or contact lenses.

Multifocal, intraocular lens implants provide high-quality vision at a variety of distances and light condition. They offer an excellent chance to become spectacle independent. They are designed to provide a continuous range of vision for distance, intermediate, near and everything in between.  Newer extended depth of focus lenses help give good distance and intermediate vision with the added benefit of decreasing glare and halos.  The recipient of any refractive lens implant will never develop cataracts because the lens implant replaces the natural lens, which is what eventually develops into a cataract.

The best candidates have mild to moderate nearsightedness, farsightedness, and/or astigmatism. Refractive Lens Exchange is also suitable for higher prescriptions. You must be over the age of 18, in good health physically and have healthy corneas.

Limbal Relaxing Incision

Used for treatment of low to moderate astigmatism. In LRI, or limbal relaxing incision, the surgeon cuts the limbus, which allows the cornea to become more rounded when it heals. These incisions are also called peripheral corneal relaxing incisions.

Compared to corneal relaxing incisions (CRI’s), LRI’s are a weaker corrective procedure; however, LRI’s produce less postoperative glare, less discomfort, and the incisions heal faster.

A good candidate must be over the age of 18, in good health physically and have healthy corneas.

Our physicians diagnose and treat nearly all eye conditions including cataracts, corneal diseases, glaucoma, diabetic retinopathy, macular degeneration, double vision, strabismus and amblyopia, eyelid diseases, dry eye, nearsightedness and farsightedness, astigmatism and presbyopia.

Our physicians see and treat many different types of injuries that occur to the eye. Some injuries require surgical intervention while others can be treated by evaluation, medications and time.

Age-related macular degeneration (AMD) is the leading cause of poor vision in people over age 60. When the macula is damaged, central vision is interfered with, so that when you look at an object straight on, part of it may seem distorted, blotted out, or shrouded in a dark haze.

The macula is the key part of the retina, the light-sensitive nerve tissue at the back of the eye that forms the “screen” upon which images are focused. Though the macular area is no larger than a pinhead, it contains all the cells needed for central vision – seeing straight ahead, seeing fine detail, and crisp color vision.

AMD usually involves both eyes, though it may start in one eye and not affect the other until much later. Most people with even advanced AMD do not lose all of their vision. No matter how poor central vision gets, your peripheral vision – the outer edge of your visual field, which does not depend on the macula – should stay useful.

What Causes AMD?

Scientists have not yet learned why a healthy macula begins to degenerate. Heredity likely plays a role, as does ethnicity – AMD is more common in Caucasians. It is also possible that tissue changes which accompany the normal aging process somehow interfere with the macula getting enough oxygen. Smokers and former smokers have been found to have a much higher risk of AMD. Other risk factors are high blood pressure and high cholesterol. The condition does not appear to be caused by diabetes or by drinking alcoholic beverages.

Drusen

As the normal eye ages, tiny yellowish deposits called “drusen” sometimes build up under the macula. The “hard” form of drusen may be a normal and harmless sign of getting older, but “soft” drusen can be a sign that degenerative macular changes are starting to develop. Yet AMD sometimes develops without any visible drusen at all.

Types of AMD

There are two major forms of AMD, called “dry” and “wet.” Most patients have the dry form, which tends to develop slowly as the tissue (pigment epithelium and visual cells) beneath the macula gradually deteriorates. With wet AMD, tissue deterioration is accompanied by tiny abnormal blood vessels called choroidal neovascular membranes. These form under the retina and start to leak fluid or bleed. If the fluid or blood reaches the macula and lifts it out of position, vision becomes distorted and visual sharpness can be lost.

Symptoms

The typical first symptom is blurring of vision. As time goes on, you may notice a hazy or dark zone in the center of objects you look at directly. Colors may begin to look different or lose richness. With wet AMD especially, straight lines, such as the edges of doorways, may start to look bent or crooked as vision becomes distorted and wavy. Symptoms may be gradual or sudden. When the loss of vision is in one eye only, you can’t always tell how long it has existed, since it is “hidden” when both eyes are used together. It may only become apparent when the good eye is covered. Some people whose vision has been very poor (from AMD or from other causes) sometimes have visual hallucinations; they see things (objects or patterns) that are not really there. These phantom visions can last from a few seconds to a minute or so and then disappear. Such hallucinations are fairly common and they are not serious, but they can be startling.

Treatment

Currently there are three main medications used to treat wet AMD. These medications can decrease bleeding and swelling caused by the abnormal blood vessels.

All patients with AMD should cease smoking if they are smokers. Vitamin supplementation with a special formula (AREDS2 formula) helps to reduce your risk of progression to advanced AMD in patients with moderate and advanced AMD.