An intregal part of a routine eye exam is the medical evaluation. Common acute conditions such as conjunctivitis, foreign bodies, ocular inflammation in the form of uveitits and other conditions are easily detected during a routine visit. Chronic conditions such as Dry Eye, Keratoconjuncivitis Sicca, Cataracts, Glaucoma, Macular Degeneration and peripheral retinal issues are critical to detect, and are routinely ruled out during your exam.

 

Dry Eye

The vast majority of ocular eye dryness is a condition caused by malfunctioning oil glands in the eyelids. A poorly formed oil layer is excreted onto the surface of the eye, allowing for evaporation of the underlying tear layer, causing damage to the ocular surface. We typically call this “Dry Eye”, but the more appropriate medical term is Keratoconjunctivitis Sicca, commonly referred to as K. Sicca.

There are a multitude of treatments for this very common age related condition including artificial tears, lubricants such as gels and ointments, tear duct plugs, topical steroid eye drops and amniotic stem cell allografts. Initial treatment is typically conservative with specific types of artificial tears. It should be noted that all OTC tear agents are not the same, and a few far outperform the majority of brands. We will be specific in our recommendations for your condition, depending on the cause. Following is a description of the newest treatment modality, and a significant contributor and cutting edge technology in the treatment of advanced ocular surface disease.

BIODOPTIX AMNIOTIC GRAFT

One new and exciting treatment for ocular surface disease is the use of the Amniotic Membrane Allograft.  Dr. Massengale is the most experienced provider in the state of Oklahoma in the treatment of ocular surface disease using the BioDOptix amniotic membrane allograft.  This transplantation of amniotic membrane to the ocular surface promotes healing of corneal ulcers, chronic corneal epithelial defects, keratitis, severe chronic dry eye, keratoconjunctivitis sicca, recurrent corneal erosions, corneal chemical burns, foreign body removal, pterygia and in other corneal disease cases.

 

An amniotic membrane is the innermost layer of the placenta, consisting of a thick basement membrane and an avascular stromal matrix. On the eye, this membrane can be used as a dressing to facilitate ocular surface reconstruction and repair, and to promote healing of the eye surface. This painless, in office procedure takes only a few minutes to perform.

The procedure consists of first placing an eyelid speculum between the upper and lower lids of one eye. The eye is anesthetized before the very thin graft is applied to the cornea. A bandage soft contact lens is placed over the allograft in order to help keep it in the location it is most needed. The speculum is then removed and the patient discharged.


Over the course of 4-6 days, the allograft is dissolved into the corneal surface.

FAQ with the procedure:

  1. Is the graft made from fetal tissue?  No. It is derived from a tiny layer of human amniotic tissue (the sac that holds a baby). If the delivering mother has consented, the amniotic sac is donated to science after her delivery..
  2. Is the graft wet? No. The graft is dry and only 40 microns in thickness.
  3. How long does it take to work?  Typically, the allograft has dissolved within 5 days.  Patients generally notice a benefit to vision and comfort within 1 to 2 weeks.
  4. Is the procedure painful? No. Inserting the speculum is usually the most uncomfortable part of the procedure, and is due to opening the eye for an extended period of time. The bandage lens may also be mildly noticeable.  Occasionally, we see an acute allergy to the allograft, and must remove it the first day or two.
  5. What if the bandage contact lens falls out? It is recommended patients do not try to put the lens back in the eye, but should contact our office immediately.
  6. Can eye drops be used after the procedure? Yes. Patients should continue to use eye drops as instructed.
  7. Are grafts tested for disease?  Yes. A rigorous testing process is used to determine the highest quality, disease-free tissue available for use in the creation of the allograft.
  8. Is this the same as a corneal transplant?  No. This procedure is for transplanting a tiny graft onto the ocular surface, for the purpose of tissue repair.
  9. Does insurance cover it?  Yes. This treatment option is reserved for moderate and severe ocular surface disease, as well as for non-healing corneal injury and disease, and is considered a surgical procedure, for which medical insurance provides coverage.
  10. Which amniotic grafts are the best? Many companies produce quality amniotic grafts. BioDOptix is the brand we use.  We have found it to be the most comfortable of the allografts we have used.

 

The patient’s vision will be mildly blurry immediately after the procedure, but will improve as the membrane dissolves over 4-6 days.


Common symptoms of Dry Eye:

 

  • A stinging, burning or scratchy sensation in your eyes
  • Stringy mucus in or around your eyes
  • Sensitivity to light
  • Eye redness
  • A sensation of having something in your eyes
  • Difficulty wearing contact lenses
  • Difficulty with nighttime driving
  • Watery eyes, which is the body's response to the irritation of dry eyes
  • Blurred vision or eye fatigue

Plan to see us if you've had prolonged signs and symptoms of dry eyes, including red, irritated, tired or painful eyes.


Glaucoma

Glaucoma is typically an age related disease caused by long term increasing fluid pressure inside the globe of the eye. This prolonged and elevated pressure eventually damages the optic nerve in the back of the eye, and if left untreated will result in blindness. This condition has no symptoms, the elevated pressure does not cause eye pain or blurred vision, and the condition does not affect your central vision for many years.


How does this testing work?

  • A battery of tests is required to gather all the pertinent information, upon which to make a diagnosis of glaucoma.
  • The test required will determine both the structure of the optic nerve, as well as the function.
  • So “true” glaucoma testing actually involves examining the retina and optic nerve at the back of the eye for signs of the disease.

Glaucoma can cause slight to severe vision loss, and is often discovered only after the disease is present—that’s why glaucoma testing is so important.


age related macular degeneration (armd)

Age-related macular degeneration — also called macular degeneration, AMD or ARMD — is deterioration of the macula, which is the small central area of the retina of the eye that controls visual acuity. The health of the macula determines our ability to read, recognize faces, drive, watch television, use a computer, and perform any other visual task that requires us to see fine detail. Macular degeneration is the leading cause of vision loss among older Americans, and due to the aging of the U.S. population, the number of people affected by AMD is expected to increase significantly in the years ahead.

Dry Macular Degeneration:

Dry AMD is an early stage of the disease and may result from the aging and thinning of macular tissues, a loss of pigment in the macula or a combination of the two processes. Dry macular degeneration is diagnosed when yellowish spots known as drusen begin to accumulate in and around the macula. It is believed these spots are deposits or debris from deteriorating tissue. Gradual central vision loss may occur with dry macular degeneration but usually is not nearly as severe as wet AMD symptoms. Dry AMD, through a period of years, can slowly progress to late-stage geographic atrophy (GA) — gradual degradation of retinal cells that also can cause severe vision loss.

Wet Macular Degeneration:

In about 10 percent of cases, dry AMD progresses to the more advanced and damaging form of the eye disease. With wet macular degeneration, new blood vessels grow beneath the retina and leak blood and fluid. This leakage causes permanent damage to light-sensitive retinal cells, which die off and create blind spots in central vision.

Choroidal neovascularization (CNV), the underlying process causing wet AMD and abnormal blood vessel growth, is the body's misguided way of attempting to create a new network of blood vessels to supply more nutrients and oxygen to the eye's retina. Instead, the process creates scarring, leading to sometimes severe central vision loss and blindness.

Wet macular degeneration falls into two categories:

  • Occult. New blood vessel growth beneath the retina is not as pronounced, and leakage is less evident in the occult CNV form of wet macular degeneration, which typically produces less severe vision loss.
  • Classic. When blood vessel growth and scarring have very clear, delineated outlines observed beneath the retina, this type of wet AMD is known as classic CNV, usually producing more severe vision loss.

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