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Items of Interest:RETINAL PHOTOGRAPHY Definition of Terms:
ZEISS VISUCAM PRO NM RETINAL CAMERA
- VISUCAMPRO NM™ –
The Non-Mydriatic Fundus Camera System from Carl Zeiss More information
 
| Smallest pupil size capture capability –
Minimum pupil diameter requirement is 3.3 mm | | Ergonomic
design, compact and easy to operate software to quickly capture and display images –
Reduced user training time equals more efficient work flow in an all-in-one imaging system | | Network ready and DICOM conformant –
Advanced integration of hardware and software | | Medical-grade
imaging sensor and ZEISS Autoflash – Brilliant true color retinal
images, perfectly exposed every time | | ZEISS
telecentric optics – Provides the highest level of optical
purity, image accuracy, and quality |
The
VISUCAM non-mydriatic fundus camera increases the quality and simplicity of fundus imaging. Compact, yet big enough to set
the standard in ophthalmic photography, it features a unique combination of functions to enhance fundus visualization and
documentation.
The VISUCAM takes an all-in-one approach incorporating
| Highly corrected ZEISS optics with an advanced professional grade digital
sensor | | Integrated patient database,
including multiple options for image comparison and review | | Quick
image transfer via network, USB stick or DVD/CD |
-
VISUCAM optimizes practice efficiency and outcomes
The VISUCAM is designed for both routine clinical use
and screening. It integrates all elements of clinical retinal photography – from image capture to image documentation
– in a single, state-of-the-art system featuring all hardware and software. Operation is easy to ensure a smooth, rapid
workflow with the help of the positioning aid with working distance dots, a focusing aid with paired coincidence lines and
ergonomic design.
Visual overview and assessment are possible at all times in every phase of the exam. When the
image is captured, it immediately appears on the 17" flat screen monitor and is automatically stored. With its 3D images
and 45° and 30° field angles, the excellent image quality of the VISUCAM makes it the perfect solution for cases which
require in-depth study. Software manages image display, editing, printing and data export. A variety of image export formats
are available. The OFFICE OF DR. HOWARD J. KASS now has the latest technology in electronic ocular documentation. RETINAL SCREENING PHOTOGRAPHY As part of your eye exam, we at the office of Dr. Howard Kass, recommend a special diagnostic procedure called Retinal Photography. This procedure consists of taking a photograph of the back
part (retina) of your eye. This is not an X-ray or an ultrasound procedure, and nothing will touch your eye. We are simply taking a picture and this is for patients of all ages, including your children. EARLY DETECTION OF EYE DISEASES CAN NOW BE EASILY
ACCOMPLISHED
BY TAKING
A SCREENING PHOTO OF THE BACK OF YOUR EYE (RETINA) This permanent record is very valuable in assessing the health
of your eye presently, and safeguarding
the health of your retina, optic nerve, macula, and blood vessels. It will also serve an initial point with which to compare as we follow your
health in subsequent years. The pictures are taken in full color.
Medical Retinal
and Front Surface Photos are billable to Insurance where
applicable but only after a screening photo is taken and an eye (ocular)
disorder is identified.
Cataracts are a sign of growing older, but they do not have to cramp your lifestyle. A cataract is a cloudiness
of the crystalline lens inside your eye. As your lens gets cloudier, your vision will gradually become more blurred. The human
eye may best be compared to a camera. When you take a picture, the lens in the front of the camera allows light through and
focuses that light on the film. When the light hits the film, a picture is taken. The eye works in much the same way. The
lens of your eye is clear and allows light to pass through. Light is focused by your cornea and lens onto a thin layer of
tissue called the retina. Your retina works like the film in a camera. When the focused light hits the retina, a picture is
taken, and sent to your brain. While a dirty camera lens blurs a picture, any significant cataract in your lens will blur
what you see. If the cataract blurs your vision severely enough to interfere with your daily routine, it is crucial that you
speak with your eye care professional immediately As
cataracts grow larger and cloud more of your lens, more noticeable symptoms will develop. These symptoms include cloudy or
blurred vision, colors that seem faded, poor night vision, and double or multiple visions. These symptoms can also be a sign
of other eye problems. If you have any of these symptoms, check with your eye care professional to find out whether or not
you have a cataract. The macula is where light focuses after passing through the cornea, pupil, and lens. The macula's function
is to sense light, and create impulses that are sent through the optic nerve to the brain the macula is responsible for central
vision, and your ability to see color, and fine detail when you look directly at an object. Macular degeneration is a disease
that affects the central vision. It is the most common cause of vision loss among people over age 60. Macular degeneration
generally takes two forms. Dry, age-related macular degeneration affects 90% of those with the disease. The earliest sign
that macular degeneration is beginning is the development of tiny areas in the macula called drusen. This form occurs when
the tissue of the macula thins over time. Since the dry form is simply a matter of the macula wearing out with age the loss
of central vision tends to be gradual over the years. This form of the disease is more prevalent, but less serious. Wet age-related
macular degeneration affects 10% of those with the disease. In this form, abnormal blood vessels grow underneath the retina.
These vessels may leak, and cause scarring, and loss of central vision if any of this damage occurs within the macula, serious
and rapid deterioration of the person's Central vision can result. This form accounts for 90% of the most serious loss
of vision cases. The dry form of this disease may convert to a wet form at any time. The wet form usually occurs in people
who already have the dry form Aging causes the vitreous
gel to become less like a gel and more like a fluid. As the eye moves, liquefied vitreous also move around inside the vitreous
cavity. This movement causes the vitreous to pull on the retina, and in time the vitreous can pull free and separate from
the retina. This is called a posterior vitreous detachment. Pulling of the vitreous on the retina can cause flashes of light.
We usually see this once a posterior vitreous detachment occurs. As the vitreous liquefies and pulls away from the retina
it becomes condensed and stringy and forms strands. We see these strands and strings as they appear as spots, circles, jagged
lines and irregular fine threads in the vision. They appear to float, and we call these vitreous floaters Presbyopia affects everyone
and usually begins to affect vision around age 40. Rays of light from near objects such as a printed page are divergent in
nature and will come to a focus behind the retina. In order for this light to focus on the retina, accommodation occurs. During
accommodation, the ciliary muscle contracts this contraction results in an increase in the curvature of the lens. Refocusing
light back onto the retina. The aging process causes a gradual hardening of your lens, causing its inability to change shape.
From age 40 onward, close work gradually becomes more difficult. This condition is called presbyopia.
Glaucoma is a disease that
gradually steals sight without symptoms, pain, or warning. Typically characterized by high pressure within the eye, glaucoma
can also occur in some cases with normal or low pressure in the eye. The eye is divided into two chambers, the anterior chamber,
or the front compartment of the eye; and the posterior chamber, or the back compartment of the eye. In a normal, healthy eye,
clear liquid, called the "aqueous humor," circulates continuously from the posterior chamber, through the pupil
and into the anterior chamber. Produced by the ciliary body, this fluid cleans and nourishes the inside of the eye. The aqueous
humor then leaves the eye through an opening in the trabecular meshwork. In an eye that has glaucoma; more fluid is produced
than can be removed by the eye, which means the fluid builds up. This built-up fluid increases pressure in the anterior chamber
of the eye. The increasing pressure in the anterior chamber eventually transfers to the rest of the eye. The optic nerve,
the weakest area of the eye, is most vulnerable to damage from this elevated pressure. Continuous elevated pressure on the
optic nerve will eventually damage the neural tissue that makes up the millions of nerve fibers that send visual impulses
to the brain. Thinning and eventual destruction of neural tissue will cause changes in the appearance of the optic nerve.
These changes are typically referred to as "cupping". It is this damage to the optic nerve that prevents light from
getting to the brain. If light signals cannot reach the brain due to severe damage, a person can go blind.
PRK PRK, or photorefractive keratectomy, has been performed
worldwide to correct myopia, hyperopia and astigmatism. PRK involves removing the epithelium, the surface layer of the cornea.
Then a computer-controlled excimer laser reshapes the cornea of the affected eye. Anesthetic drops in the eye ensure that
the patient experiences as little discomfort as possible. While the long-term
visual results achieved are predictable and stable, patients experience discomfort for 24-48 hours while their epithelium
regenerates. Additionally, the initial visual recovery associated with PRK is not a fast as with LASIK, although data demonstrate
that visual recovery is the same as with LASIK by approximately 3-6 months. Typically both eyes are not treated at the same
time, though they may be. Patients typically wear bandage contact lenses for pain reduction for a few days while the epithelial
tissue regenerates and use postoperative eye drops for up to four months. As with any surgery, there are risks involved. The
complications associated with PRK are similar to those with LASIK. Patients should discuss that information in detail with
their surgeons. A slight variation on the traditional LASIK procedure is becoming available, LASEK. This procedure may be an option
for patients who are not good candidates for the traditional procedure. LASEK
is a relatively new surgery that utilizes a trephine to create an epithelial flap (as opposed to a deeper stromal flap with
LASIK) and an alcohol solution to preserve the epithelial cells. Once the epithelial flap is created and lifted, the treatment
proceeds as for traditional PRK, with light smoothing at its conclusion. Then, the epithelial flap is repositioned with a
small spatula. LASEK preserves more corneal tissue, on average, than a typical
LASIK procedure. Therefore, for patients who have thin corneas, LASEK may offer a safer alternative than LASIK. Several small peer-reviewed studies have recently been published about the LASEK procedure.All
have concluded that this technique has the potential for use within the clinical practice, noting patients achieved results
similar to those achieved with LASIK or PRK. All also noted that additional long-term studies were needed to confirm these
early results. As more ophthalmologists are trained in the procedure and offer this technique as an alternative to patients,
we expect to see more studies collaborating these initial results. On those
lasers that have earned approval based on PRK or LASIK data, LASEK is permitted as a practice of medicine. The use of devices
during a procedure deemed a practice-of-medicine is called an "off label" use of these devices. Because the approved
lasers and trephines have proven safe and effective in other procedures, ophthalmologists may use them off-label if they feel
it is in their patients' best interest to do so. LASEK may offer
patients with thin corneas a viable option to preserve more corneal tissue. However, the LASEK procedure is relatively new
and is an off-label use of the excimer laser. Patients should be sure to discuss this option fully with their ophthalmologist.
Laser Thermal
Keratoplasty (LTK)
- LTK
has been approved by the US FDA for temporary reduction of moderate hyperopia (+0.75D to +2.50D) with or without mild astigmatism
(up to 0.75D). Patients must be 40 years or older. The procedure produces a change in the refractive power and properties
of the cornea by using the heat produced by holmium laser light to modify the structure of the cornea's collagen fibers.
LTK involves the strategic placement of 16 laser spots onto the peripheral cornea. First the
eye is numbed with anesthetic drops and held open with an eyelid holder so that the tear film can dry for 3 minutes before
the laser is applied. The laser application itself takes less than 3 seconds per eye. The treatment thermally contracts the
tissue, causing the central cornea to steepen. A bandage soft contact lens is usually placed on the eye until the following
day. They eye may have some irritation for the first few days. Automated Lamellar Keratoplasty (ALK)In ALK, the surgeon uses the microkeratome to separate a layer of the cornea and create a flap.
The flap is then folded back, and the microkeratome removes a thin disc of corneal stroma below. The thickness and diameter
of this disc determines the change in refractive error. The surgeon then places the flap back into position. This procedure
can correct large amounts of myopia and hyperopia. However, the resultant change is not as predictable as with other procedures.
Conductive
Keratoplasty
- Used to treat
hyperopia, CK steepens the central cornea by using radio frequency energy to shrink the collagen in peripheral cornea. With
CK, the surgeon uses a radio frequency probe rather than a laser to apply the heat. One published multi-center study reports
12-month data on 203 eyes and notes that 51% had uncorrected visual acuity of 20/20 or better at that point.1 The device used in the technique received FDA approval in April 2002.
According to the Reuters 2, the procedure takes approximately 3 minutes and can be performed in the surgeon's office. Patients may experience
visual fluctuations for the first couple of weeks following the surgery. The report states that studies have demonstrated
the effects last for at least two years. One percent of patients developed induced astigmatism as a complication of the procedure.
Micro-thin Prescription
Inserts
- Micro-thin Prescription
Inserts INTACS™ are two small arcs of medical plastic that a surgeon places into the mid-periphery of the corneal stroma.
Once in place, the inserts cause a slight stretching of the cornea and a subtle flattening of the corneal curvature. The change
in curvature varies with the thickness of the inserts. To place the inserts, the surgeon must first create a small incision
in the periphery of the cornea. The inserts are then placed. Finally, the surgeon closes the incision (a suture may sometimes
be required). Once placed, the inserts can be removed or replaced by the surgeon if the patient's vision needs change.
Under U.S. clinical study since 1991, KeraVision INTACS™ received FDA approval for the correction of -1.00 to -3.00
D of myopia with no more than 1.00 D of astigmatism in April 1999.
Multiple Procedures
- Doctors will sometimes use two or more procedures
to treat patients suffering from high to severe myopia. For instance, ophthalmologists have inserted phakic IOLs and then
performed LASIK to achieve the desired refraction in eyes with more than -15D of myopia pre-operatively. Surgeons have also
performed initial LASIK procedures then inserted ICRS to correct residual errors.
However, patients should understand that the use of multiple procedures is a relatively new option in many countries,
including the United States. Very little study data has been accumulated on the long-term effects of multiple procedures,
and patients may need to look harder to find a surgeon currently performing such procedures in combination with one another.
RK
- Radial keratotomy, or RK, was, refined by a Russian
ophthalmologist in 1963 and involves using a diamond scalpel blade to make usually four to eight tiny spoke-like incisions
in the periphery of cornea. The incisions slightly weaken the peripheral cornea, causing it to bulge. This flattens the center
of the cornea, thus reducing myopia.
RK has its drawbacks. The resulting
change in refractive error is felt to be less predictable because no one can control the way the incisions heal. As a result,
RK may only reduce myopia, not completely eliminate it. RK patients may still need to wear glasses for distance. In addition,
with time, RK can result in overcorrection. Because of advances in laser
technology, surgeons perform RK only on a select group of patients |
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