Services



Services

General refractive and contact lens eye exams

For our patients who need regular dilated eye exams we offer complete comprehensive eye exams for both new and existing patients. Our general ophthalmologists provide these exams.

Included in all exams are refraction and prescription for glasses, intraocular pressure measurement, corneal measurement (if necessary for contact lenses), and a full health exam.

It is stressed by our physicians that our patients be seen on at least a yearly basis for a dilated eye exam and pressure check. This is especially true for those patients over the age of 45 to check for glaucoma. For those who have medical conditions such as: Diabetes (type I or II), High Blood Pressure, Lupus and other auto immune or systemic problems. Our doctors will evaluate and discuss with you how to best follow how your eyes are being affected by these health problems. Most eye disease is manageable but needs to be followed regularly to reduce the risk of vision loss due to eye disease.

Since we are a medical office most of our eye exams are covered by health insurance rather than vision insurance. If you do have both vision and health insurance it is important that we have both types of insurance on file in case a future eye problems arises within the calendar year which vision insurance will not cover. We are always happy to discuss insurance filing, and in those cases where two types of insurance exist which provider you would prefer to use.

Urgent care for ophthalmic trauma or infection

For our patients that have an urgent eye need we are available with a doctor on call everyday and after hours. Patients are encouraged to call our office and a technician will speak to you and find an appropriate time for you to see and speak with our doctors. We do triage our calls and in some cases it is not necessary to be seen immediately, in these situations a doctor will be consulted, solutions offered, and the next available appointment with your doctor will be offered contingent on whether solutions offered effectively treat symptoms.

Save a few exceptions, these evaluations are all considered MEDICAL problems and will be filed under medical insurance. Most vision insurance only covers a specific type of eye exam and not problems or emergency care. If you are experiencing problems after normal business hours: 8-4:30 M-F, our answering service will answer your call and page the doctor on call and that physician will call you to address any problems you are having. If you have to be seen in the office during "after hours" special fees will apply.

It is important for patients to call with any concerns so that we as a staff can address your questions and concerns, often these are situations that are normal but are unfamiliar to you as a patient. We especially encourage our post operative patients to call with concerns and questions so they can be address quickly and effectively.

Evaluation for high risk medication

There are some medications that have been shown to have a risk for affecting vision in one way or another. We see these patients usually in conjunction with a complete eye exam, as noted above, with several special tests which can include some of the following: visual field testing, Ocular Coherence Tomography, corneal topography, depth perception, and color vision testing. These tests are done by a technician and explained and interpreted by your doctor, a letter is also sent to the physician who prescribed the medication. Most common medication tested for is Plaquenil, and requires regular visual fields and color vision testing.

Cataract Evaluation and Surgery

Cataract evaluation is done either during a regular yearly eye exam or when patients are referred for cataract evaluation specifically. Cataract surgery is an outpatient procedure done with as little invasion into the eye as possible. Several measurements are taken and lenses are calculated based on these measurements. While cataract surgery has a exceptionally high success rate, it is still important to discuss and ask questions of your physician to help you as a patient decide whether cataract surgery is right or necessary for you.

Dr. Gary R. Rylander and Dr. R. Todd Smith are our two physicians who perform cataract surgery, and Cookie Hogan schedules when and where the surgery will be performed. We operate out of two Hospitals: Seton Central on 38th street and Bailey Square Surgery Center on 34th street. Below are some terms and tests that may help you understand what a cataract is and how we measure for intraocular lenses.

Cataract- Opacity of the crystalline lens, which may prevent a clear image from forming on the retina. Surgical removal of the lens may be necessary if visual loss becomes significant, with lost optical poser replaced by an intraocular lens.

* IOL master- An instrument that takes five different measurements needed for cataract surgery and calculates the appropriate intraocular lens power for your eye. This instrument requires no contact with the patient's eye and uses light to achieve necessary measurements.

* A-Scan- An instrument that takes the measure of the eye length and anterior chamber depth. Then using corneal measurements taken separately, this instrument is able to calculate the appropriate intraocular lens power for your eye. This instrument does require the technician to very lightly touch the surface of the eye after placing an anesthetic drop in the eye to numb the surface. The measurement is achieved using sound waves and is especially useful for getting accurate measurements for our patients with very dense cataracts.

Corneal evaluation and treatment

Our clinic offers a wide range of expertise regarding corneal issues and treatment. All of our general ophthalmologists can treat most corneal disease. Dr. Gary R. Rylander performs cornea transplant surgery and is a specialist in corneal evaluation and treatment. Below are a list and definition of some of the main corneal diseases that we see and treat.


Keratoconus - A pathological condition that is characterized by general thinning and cone shaped protrusion of the central cornea, usually in both eyes. It is a degenerative corneal disease that affects vision, requiring special contacts and in some cases corneal transplant surgery.

Corneal edema - A hazy or swollen cornea, limiting the vision by scattering the light as it enters the eye. Also called a "steamy" cornea by appearance.

Corneal Abrasion - Scraped area of corneal surface, accompanied by a loss of superficial tissue.

Corneal ulcers - Area of epithelial tissue loss from the corneal surface. Associated with inflammatory cells in the cornea and anterior chamber (area between the iris and cornea). May be caused by bacterial, fungal, or viral infection often related to contact lens overwear.

Cornea transplant - A surgical procedure that replaces scarred or diseased corneal tissue with clear corneal tissue from a donor

Fuch's dystrophy

Dry eye Syndrome - Characterized by corneal and conjunctival dryness due to deficient tear production, can cause a foreign body sensation, burning eyes, corneal scratches, and erosion of conjunctival and corneal epithelium

Graves disease - Eye signs that may occur with excessive thyroid-related hormone concentration. Includes eyelid retraction, eyelid lag on downward gaze, corneal drying, eye bulging, fibrotic extraocular muscles, and optic nerve inflammation.

Sjogren's syndrome - Chronic connective tissue disorder characterized by dry eyes, dry mouth and arthritis

Map dot fingerprint dystrophy - Common corneal epithelial basement disease characterized by cysts, dots, or lines that may change in pattern and distribution over time and resemble a map. Can be bilateral, or affecting both eyes, may not have any symptoms or can lead to recurrent corneal erosions

Bullous Keratopathy - Degenerative process in which small blister-like pockets form in the swollen corneal epithelial layer.

Superficial Punctate Keratitis - Corneal disease characterized by small superficial corneal lesions. Symptoms include foreign body sensation and sensitivity to bright light.

Band Keratopathy - Horizontal band of calcium deposits in the superficial layers of the cornea, associated with chronic ocular diseases

Corneal Scars- A scar formed within the tissue of the cornea that

Foreign body removal and treatment

Glaucoma evaluation, treatment,& management

Our patients with glaucoma require closer follow than the majority of our patients. It is necessary to do a dilated exam at least once a year, however, it is important to follow eye pressure regularly every 4 or 6 months as determined by your physician. Visual field testing is done one or two times a year in most cases to determine how much if any the disease has progressed. OCT is performed every 6 or 12 months to look at retinal nerve fiber thickness and monitor progression of disease. Below are some helpful terms that may help you better understand your disease and why it is so important to closely monitor your vision and eye pressure.

Glaucoma - Group of diseases characterized by an increase in intraocular pressure resulting in damage to the optic nerve and retinal nerve fibers. Characterized by typical visual field defects and increased sized of optic cup. A common cause of preventable vision loss. May be treated by prescription drugs or surgery.

* Visual field - A test to measure the full extent of the area visible to an eye that is fixating straight ahead.

* Ocular Coherence Tomography - A non-invasive test which uses light waves to measure retinal nerve fiber damage as well as produce an anatomical analysis of the optic nerve, is used in conjunction with the visual field to monitor glaucomatous progression

* Peripheral iridotomy - In-office surgical procedure that uses a laser light beam to burn a hole through the iris near its base. Allows aqueous humor to drain freely from the posterior chamber to the anterior chamber.

* Intraocular pressure management via topical eye drops - Topical drops are used to manage glaucoma and are determined by the doctor which drops may be effective for you.

Treatment & evaluation of Vitreo-Retinal diseases

Dr. Jack Pierce is our retinal specialist, though all of our physicians do retinal exams. Dr. Pierce specializes in treating diseases that are specific to the retina and vitreous which together compose the posterior part of the eye.

Dr. Pierce only takes medical insurance because all of the problems that he sees are considered medical diagnoses. Retina evaluation requires dilation of both eyes (unless otherwise specified and in these cases only the affected eye is dilated) so that Dr. Pierce may see to the back of the eye and assess any pathology that may be present. Below is a list of many of the diseases that we see. Often additional testing is required to secure a diagnosis. Dr. Pierce will discuss with you the reason for the test and will discuss and interpret the test with you. The most common tests done are: fundus photography, fluorescein angiography, OCT, and B-Scan.

Diabetic retinopathy (BDR, PDR) - Series of progressive retinal changes accompanying long-standing diabetes mellitus. Early stage is background (non-proliferative) characterized by clinically significant macular edema, dot-bot hemorrhages, and retinal deposits. Can progress to proliferative diabetic retinopathy characterized by new abnormal blood vessel growth (neovascularization) and accompanying fibrous tissue.

Age Related Macular Degeneration (Wet and Dry)- Group of condition that include deterioration of the macula resulting in a loss of sharp central vision. Two general types "dry" which is usually evident as a disturbance of macular pigmentation and deposits of yellowish material under the pigment epithelial layer called "drusen"; and the "wet" form in which abnormal new blood vessels grow under the retina and leak fluid and blood (neovascularization), further disturbing the macular function. Is the most common cause of decreased vision after age 50.

Pre-retinal fibrosis - Scar tissue that forms on the surface of the retina that can lead to retinal detachment, tears, macular pucker/traction, or macular hole

Macular pucker/traction - Retinal wrinkling in the macula caused by contraction of the transparent membrane lying on the retinal surface, can cause visual distortion

Macular hole - A full thickness hole in the macular area usually severely limiting vision, usually caused by traction created by pre-retinal fibrosis. Requires intraocular surgical repair.

Retinal detachment - Separation of the retina from the underlying pigment epithelium, almost always caused by a retinal tear. Disrupts visual cell structure, markedly disturbing vision. Often requires immediate surgical repair

Retinal tear- A small separation from the retinal from the pigment epithelium, that can be caused by vitreous detachment, high myopia or trauma, can lead to a retinal detachment if not caught or treated. Usually treated with laser photocoagulation.

Central Serous Retinopathy - Blister-like elevation of the sensory retina in the macula, with localized detachment from the pigment epithelium. Results in reduction and/or distortion of vision that usually recovers in a few months.

Posterior Vitreous Detachment - Separation of the vitreous gel from the retinal surface. Usually innocuous, but can cause retinal tears, which may lead to retinal detachment. Frequently occurs with aging as the vitreous liquifies and condenses.

Retinitis Pigmentosa - Progressive retinal degeneration in both eyes. Night blindness, usually in childhood, is followed by loss of peripheral vision progressing over many years to tunnel vision and finally blindness.

Pseudo tumor cerebri - Intracranial inflammation that resembles a brain tumor. Causes intracranial hypertension and can result in optic nerve head swelling, headaches, protrusion of the eye ball and transient loss or reduction of vision.

Cystoid Macular Edema - Retinal swelling and cyst formation in the macular area; usually results in temporary decrease in vision, though may be permanent. Frequently occurs to some extent after cataract surgery.

Ophthalmic Testing

Ocular Coherence Tomography - This test is non-invasive and uses light wave to measure and analyze different physiological structures in the eye. The central macula scan is used to look at the retina fiber layer in the central retina or Macula to determine whether any fluid, holes, scar tissue, or swelling is present that is adversely affecting your vision. This allows the doctors to determine what course of treatment is needed to improve vision. OCT is also used to analyze the optic nerve in glaucoma patients. The glaucoma scans are done of the optic nerve and look at the anatomy of the nerve itself as well as the retinal nerve fiber thickness around the optic nerve, and analyzes the progression and severity of the disease.

Fundus Photography - Color pictures taken of either the outer, or anterior, or inner, posterior, portion of the eye to look at and document changes that have occurred in your eye. This is done using a special retinal/fundus camera for high resolution

Fluorescein Angiography - Pictures taken of the eye to determine new blood vessel growth (neovascularization), areas of swelling or fluid, and amount of fluid present in affected area. This is achieved by injecting a yellow (fluorescein) dye into an arm or hand vessel and taking pictures of the dye as it enters the eye. The dye is filtered though the kidneys so skin may look a bit yellow or jaundice and your urine may be a bright yellow/orange for a day or so. The dye itself is vegetable based, but if you have had any reaction to dyes or injection in the past please inform the staff because this dye has been known to cause adverse reactions in some people.

Corneal Topography - Measures the outer surface of the eye, or cornea, and produces a geographical map of the cornea. This test is most often used for our corneal transplant, keratoconus, and difficult contact lens fit patients.

A and B Scan ophthalmic sonography - A scan uses sound waves to measure the length of the eye and the anterior segment (from the back of the cornea to the iris) for cataract surgery. This does require contact with the eye, so the technician performing the scan will numb the cornea with a topical anesthetic drop. B scan does a sweeping scan using sound waves to give a 2 dimensional look at the eye. This test gives an image similar to those seen during pregnancy exams, but is used to look for retinal defects in eyes that have a significant hemorrhage, severe iritis, uveitis, or dense cataract that prevents the doctor from seeing the retina either clearly or at all. This scan is done through the eyelid son no numbing drop or contact gel is usually needed to get an image.

Visual Field testing - Tests the peripheral vision of patients who have glaucoma, take high risk medication, have pseudo-tumor cerebri, or other ocular issues that the doctor feels it necessary to check the peripheral vision for defects.

IOL master - This is a non-contact test that takes measurements necessary for cataract surgery, this test is the standard of care for cataract measurement. It takes the place of the A scan, however, A scan will still be used for patients with dense cataracts or other ocular history that limit the IOL master from taking measurements.

Contact Lens Department

Soft contact lenses - Are made from flexible water absorbent plastics. Some contacts are meant to be replaced daily while others are removed nightly and replaced on a two week or monthly schedule dependent on type of lens that you are wearing. Soft contacts are usually easy to insert and fit. Cheryl is our contact lens specialist and she will take a few measurements of the corneal curvature to achieve the best fit possible in soft contacts. There are several different types of soft contacts that are available and are listed below.

* Multi-focal - These lenses are designed to work for those patients who need bifocal correction, and have concentric rings with different correction so the patient can see both to read and when looking off into the distance.

* Spherical - These lenses are corrected for distance vision only and have no correction for astigmatism or bifocal

* Toric/Astigmatic - These lenses are designed to correct both distance and astigmatism and are weighted to sit appropriately on the eye. It does often take longer for these lenses to "settle" so the vision is clear out of the lenses, usually though this length of time is 5 to fifteen minutes. These lenses are specifically for those patients who have a significant astigmatic correction determined by your doctor

* Mono vision - These lenses are for patients who need bifocal correction, one eye is corrected for distance vision (usually the dominant eye) and the other eye is corrected for reading correction or is "under-corrected" (usually the non-dominant eye). The eyes work together then but one eye takes over at distance and the other when reading.

Gas permeable lenses - Are made of special plastic that allows for the passage of oxygen and other gasses. These lenses are very durable and give you crisp vision. These lenses are often recommended for patients with very high astigmatism or other corneal diseases that require more specific fit than soft lenses offer. These lenses take longer to get used to and new wearers have to "ease" into wearing these lenses by wearing for short periods and lengthening wear time as you become used to them.

Contact lens fitting and evaluation - Cheryl is the contact lens specialist and based on her expertise and the prescription given by our doctors she will fit you in a lens that you feel most comfortable wearing. There is a contact lens dispensing and fitting fee which will be determined by Cheryl after assessing your contact fit and type of lens you will most likely need. This fee covers all trial lenses given as well as any visits necessary to check the fit and comfort of the lenses for the three months after your eye exam.

As with all cases you, your doctor, and Cheryl will work together to determine which is the best type of lens for your eyes.

Optical Dept.

Glasses

* Lens ordering and measurement

* Glasses repair