A: Most nearsighted or myopic patients with minor astigmatism and healthy corneas are capable of being fit into contact lenses. The strength of the prescription does not exclude patients because contacts are available in a wide range. For the few patients that do not fall within the soft contact lens parameters the option of gas permeable lenses should be discussed. I find most moderate to severely myopic patients have better peripheral vision with their contacts versus spectacles. My recommendation for the nearsighted patient with a high prescription that may become intolerable to contacts or elect another option is a new surgical technique known as ICL or implantable contact lenses.

 A:  Cataracts, which represent clouding of the natural lens inside the eye, are caused by changes in the proteins making up the lens.  These changes occur in everyone as part of the natural aging process, with much of the variability in rate due to genetics.  Smoking, exposure to excessive sunlight, diabetes and medications such as prednisone and diet deficient in antioxidant vitamins C and E all accelerate these changes.  Most people have some degree of clouding of the lens once they reach their 50's, and if not before then this often becomes visually significant in one's 60's or 70's.  Typical symptoms of cataracts are blurred vision with activities such as reading, driving (especially at night), increasing glare and frequent changes in glasses prescription.  Fortunately cataract surgery can now be performed without shots, stitches or patches - "Shugarcaine" is the only anesthetic designed for intraocular use, which greatly increases the safety and comfort of the no shot procedure.  Additionally we now have premium lenses for use at the time of cataract surgery that can restore excellent vision without glasses at near as well as distance, allowing for a much more youthful higher quality of vision.

 A: Eyesight deteriorates with age for many reasons.  The first change people typically notice is the loss of near vision that becomes significant in the mid 40's.  People who didn’t need any glasses beforehand, require reading glasses while those already in glasses require bifocals or progressives.  This condition, known as presbyopia, results from a loss of flexibility of the lens inside the eye and is a universal constant of human aging.  This process continues throughout middle age and this lens also develops progressive clouding, a condition known as cataract.  This causes a loss in clarity of vision not fully corrected by glasses, typically starting with glare when driving at night, trouble reading fine print, eyes fatiguing and watering after reading for a few minutes, frequent changes of glasses prescription and other similar symptoms.  The time to have cataracts removed is when these symptoms become problematic.  Cataract surgery can be performed without shots, stitches, patches or even an IV as a very short same day procedure that typically results in instantaneous or very rapid visual recovery.  Premium lens implants are now available that will not only correct distance vision after cataract surgery but will allow each eye to see distance, intermediate and near without glasses, resulting in a more youthful quality to vision.  Finally, diseases such as age-related macular degeneration and glaucoma become increasingly prevalent with increasing age. 

A: Unilateral pupillary dilation is known as a tonic pupil.  Trauma is the most common cause.  Other causes can include viral illness, diabetes, syphilis and giant cell arteritis.  When the cause cannot be identified, the condition is termed Adie's tonic pupil, which is most common in young women.
 

A:   In the vast majority of cases, the artificial lens placed in the eye following cataract surgery will last for the remainder of a person's life.  The need for intraocular lens exchange is quite rare, and is usually associated with either complications that occurred during the original cataract surgery or conditions such as Pseudoexfoliation that are associated with progressive weakness of the fibers supporting the lens, resulting in late dislocation.  However; quite frequently months or years after cataract surgery the membrane, in which the lens is encased can develop clouding as part of the natural healing process.  This clouding is easily cleared with a single YAG laser treatment that can be done at the same time as an office visit and which almost never needs to be repeated

 A:  If you are 55 years old and able to do close up editorial work without glasses you are doing fantastically well!  Our ability to shift focus from distance to near is called accommodation and starts decreasing from the time of birth.  For most people, this age-related decline (called presbyopia) becomes significant by the mid 40's, and those who see well at distance without glasses require reading glasses, while those who are in glasses for distance require bifocal or progressive lenses.  A few fortunate individuals are able to make it into their 50's before reading glasses become necessary but eventually this happens to everyone.  Consider yourself fortunate.

A:  The chances for developing retinal detachment after cataract surgery vary tremendously based upon the preoperative refractive status, age and gender of the patient as well as whether or not there were complications during surgery.  A person who was farsighted or without much focusing error prior to surgery and who underwent uncomplicated surgery would have extremely remote chances for developing retinal detachment postoperatively.  The combination of factors posing the greatest risk are high nearsightedness preoperatively (typically too nearsighted to be able to even read without glasses), male gender, young age and the occurrence of operative complications such as posterior capsular rupture and/or vitreous loss.  Advanced surgical techniques such as microincision phacoemulsification surgery with capacity to minimize intraocular pressure fluctuations during surgery may further reduce risks of postoperative detachment.  For these reasons it is particularly important to choose a highly experienced cataract surgeon who uses the latest generation of phacoemulsification equipment, such as the Alcon Infinity system, particularly if a patient has one or more risk factors for retinal detachment or for other surgical complications (such as a history of prior ocular surgery or conditions such as glaucoma or diabetes).

 There are many options for correcting nearsightedness.  Laser surgery is the most common and well known, and is typically the most appropriate technique for younger patients without corneal abnormalities requiring correction of mild to moderate nearsightedness.  LASIK is the most common type of laser vision correction, and in many cases WaveFront-driven LASIK offers the potential to correct vision shaper than glasses or contacts by correcting errors of the eye that can’t be corrected by optical means.  In cases of sever nearsightedness or in patients whose corneas aren’t optimal for LASIK, the implantable contact lens (ICL) provides far superior outcomes.  For others, lens-based surgery will offer the best results.  Technology and surgeon experience is of critical importance to obtain the best outcome and to select the right procedure, so one should select a surgeon with extensive experience with all of these modalities and who has advanced equipment such as Orbscan to ensure corneas are optimally suited for LASIK and WaveFront correction capabilities.

 A: Anisocoria, or pupils that are differently sized, can result from one pupil being abnormally small or from the other pupil being abnormally large.  An abnormally small pupil may be due to Horner's syndrome, which can be caused by a variety of problems ranging from trauma to aortic or carotid dissection, tuberculosis, Pancoast's tumor, cluster migraine headache, or neck or thyroid surgery.  An abnormally large pupil can be due to Adie's syndrome (sometimes caused by bacterial or viral infection) or something as serious as an aneurysm.  There are many other causes for unequal pupils, some of which are serious and others benign.  You should see a qualified ophthalmologist, an eye-MD who has been through medical school and then spent at least 4 additional years of specialty training in medicine or surgery and then ophthalmology for an accurate diagnosis.  Regarding treatment, Adie's pupil can often be treated with medication while pupils that are too small can be enlarged using laser surgery.  In rare cases (usually associated with trauma), pupillary abnormalities are best addressed with intra-ocular surgery.