Author: Boston Eye Physicians and Surgeons

Having vision problems such as blurry vision and headaches?

Let’s look at one of the group of eye diseases known as glaucoma.

Glaucoma is a complicated disease in which damage to the optic nerve results in vision loss.

While there are several forms of glaucoma there are two main forms that doctors see most frequently – open-angle glaucoma (POAG) and angle-closure glaucoma (ACG). Despite being grouped together under the disorder glaucoma, these two disorders have completely different symptoms. 

Symptoms of Glaucoma 

There are many signs and symptoms of glaucoma you can look out for. If you’re looking more into the symptoms, check out these two types of glaucoma and see if your symptoms match.

Primary Open-Angle Glaucoma

Signs and symptoms of Primary open-angle glaucoma include: gradual loss of peripheral vision, usually in both eyes and tunnel vision in the advanced stages. Unfortunately, there are typically no early warning signs or symptoms of open-angle glaucoma. It develops slowly and sometimes without noticeable sight loss for many years. By the time a patient is aware of vision loss, the disease is usually quite advanced. This makes regular eye doctor appointments critical to diagnosing glaucoma.

Acute Angle-Closure Glaucoma

Signs and symptoms of acute angle-closure glaucoma include: Eye pain, Nausea and vomiting (accompanying the severe eye pain), Sudden onset of visual disturbance, often in low light, Blurred vision, Halos around lights, and Reddening of the eye. In contrast with open-angle glaucoma, symptoms of acute angle-closure glaucoma are very noticeable and damage occurs quickly. If you experience any of these symptoms, seek immediate care from an ophthalmologist.

If your doctor diagnosed you or a family member with glaucoma, it is important to set a regular schedule of examinations in order to monitor your condition and make sure that your prescribed treatment is effectively maintaining a safe eye pressure. If you have questions about your eye health or your current symptoms, reach out to our office and schedule an appointment.

Years ago, Beth Israel was the first area hospital to start computer based medical record keeping and continues in that fine tradition. Today, also since early this year, customized preop medication orders from outside clinicians like me are generated without paper, reducing risk of errors.

How likely are errors? With so many fields of medicine, such as ours, ophthalmology, each with unique medicine formulations, the error rate elsewhere can be high.

How nice it is having the comfort at BIDMC, that eye drops are selected in a failsafe pharmacy environment.

The glaucoma and cataract surgeries I performed today seemed to fly by as the skilled team of circulating and scrub nurse specialists – Flor, Alma, Richie – and others, flawlessly made each patient’s surgery a serious and focused undertaking of personal importance.

As soon as the patch is removed In the morning, these patients will have good vision – no longer suffering lost eyesight from those diseases. Happily surgery is painless for nearly everybody. And the eyesight reward is without measure.

Your eye is red, painful, and the vision is blurred, with haloes around lights, add nausea; then acute angle closure glaucoma is a fairly obvious diagnosis.   That eye will be partly blinded by this attack.  But one of the most difficult diagnoses in all of eye care is the common related condition – chronic angle closure glaucoma.   The condition which may in fact precede an acute attack.

The doctor must place a mirrored contact lens on your ocular surface, while you cooperate as best you can to permit the doctor to study a circle of tissue 50 microns wide (0.050 millimeters!) that is inspected through the mirror.   [The Barkan gonio lens was a direct technique for such inspection, eliminating the mirrors, but the patient must lay flat (a position normal to us only during sleep) and the doctor must hold a 15 pound microscope to see the fine details.]

Easy to imagine that subtle trouble with the observations will, and often do, happen.  When the drainage angle for fluid closes in part, pressure in the eye will increase slightly.  The goal of treatment is to remove the obstructing iris folds which roll up to and over the fine meshwork which percolates fluid through and out of the eye.

The treatment?  Create a second opening in the iris other than the pupil, which will allow fluid to pass directly to the drains, and eliminate the pupil – blocking part of the fluid stream.

This was performed by surgery prior to the 1970s but the advent of laser technology improved surgery.  Each generation of laser has proved effective at puncturing a hole in the iris, without surgically opening the eye.  The surgeon’s  job is to ascertain who will benefit from this procedure as to eliminate the folds which block fluid exiting the eye.

Patients come in for a routine eye exam, and they may have partly or completely blocked drains.  If the eye pressure has – or has not – built up, should a laser treatment be recommended?  How risky is it for the laser treatment, verses the risk of having low grade glaucoma, or even an acute attack – as decribed at this blog’s outset?

Even second opinion glaucoma patients arrive with the same dilemma – are they “open angle” or “closed angle” patients – and are the treatments correct?

A yearly “gonioscopy” by your eye doctor is an important part of maintenance for every glaucoma patient, and we will perform this exam in any patient with suspicious findings seen during the course of any eye examination.

Traveling to Singapore, Netherlands, Or Prague.  Next year in Beijing?  For me, not this year:

Nice and simple to take the MBTA Green D Train 4 stops to the Hynes in Boston to rendez-vous with every major glaucoma contributor in the contemporary literature…

A thumbnail of news from the meeting – a fair amount devoted to world issues of health access in Africa and Asia.  Increased recognition of populations with higher risk for the disease?  Caribbean and west African blacks, Japanese with normal tension glaucomas, and aboriginal communities with angle closure disease.

What about medical breakthroughs?  This year’s research award to a North Texas cell biologist who characterized the WH-1 gene in mouse, showing “up regulation” and “down regulation” of intraocular pressure by chemical messaging of proteins to (mouse) trabecular meshwork.  This is important because chemical messengers may be critical for a permanent cure, or for definitive diagnoses.

What is trabecular meshwork?  This important tissue regulates eye pressure by controlling egress of the nutrient aqueous fluid that circulates through and inflates the eye.  Too little exiting?  High pressure.  Is there a over -secretion glaucoma, patients ask?  These are rare and sporadic.  The principal cause of the disease is failure of fluid leaving the eye.  All glaucoma treatments are directed at resolving this defect.

Dr. Kevin Kaufman

Are you familiar with the best contact lenses for you? At BEPS, we help our clients find the perfect pair of contacts depending on their eye health, specific needs, routines, and daily care. When you come to BEPS for a contact fitting, we help not only by fitting you for your contacts, but by educating you on contact care, giving you pointers and tips to keep your contacts safe and fresh for as long as intended. Let’s take a look at the process:

Contact Fitting at Boston Eye Physicians & Surgeons

BEPS fits both soft contact and hard contact lenses for our patients. There has even been a new trend of adults getting fitted for contacts. At BEPS, we’re finding that most of these people had tried contact lenses over 20 years ago. They experienced difficult fits and contacts that were hard to wear for any length of time.

Most are not aware of the comfort, value and the many types of lenses available to our patients. Finding the right fit is important for your comfort and the safety of your eyes. After your exam, you have options and we guide you towards what we think will work best for you.

Everyone wears contacts differently. Some people enjoy the one day use contacts, where they’re removed and replaced each day. Some people like the month long contacts in which you save the same pair of contacts and return them to your contact case in the solution every day. Each type of contacts are different and work for different reasons. It’s all about what feels natural to you, and depends on your routine.

Different Brands of Contacts

Wether you need dailies, monthlies, astigmatism, or bifocal lenses, we have all the best brands to fit you with.

You may be looking into contacts for a number of reasons. If you’re experiencing difficulties with your current contacts, or looking into different brands available to you, there are so many options. Maybe your current contacts don’t fit well anymore, or maybe your prescription is old. When clients come to our office, we find the best contacts to fit their needs. If you’re uncomfortable with your current contacts, don’t feel like you have to stick with the ones you have. There are so many different choices available to you!

The Actual Contact Lens Fitting

When we decide on contacts together, we help you put contacts in your eyes and try them out before leaving our office. This allows us to help you put them in as it can be very difficult, especially if it’s your first time ever wearing contacts. Most would think it would be a simple process, but you’ll want expert help from BEPS when it comes to learning how to safely put in and remove the specific contacts you choose.

When you get a new brand of contacts, you may think they’re going to be perfect, but you really need to give them some time to see how they fit. We help our clients put contacts in, have them read a few things, and walk around a bit to test brightness, depth perception, etc. Every pair of contacts is different and we know each of our clients require contacts for different needs. We’ll be sure that your new contacts are working exactly how they’re supposed to be working for you so you can go about your routines without any disturbances or annoyances.

Remember: Contact Lens fittings are considered cosmetic and are not covered by insurance. Please call our office today to schedule a fitting. 

Hi there,  I am Rob Stone, Clinical manager and Ophthalmic tech for Boston Eye Physicians and Surgeons(BEPS).

I am proud to work for doctors like, Dr. Richard Floyd, Dr Anthony Fraioli, Dr. Ernest Kornmehl and Dr. Kevin Kaufman.  They are the core of this wonderful practice that is also complimented by Dr’s Robert Gorn, Caroline Baumel, James Lee, J. Wallace McMeel and Peter Rubin.

All of them dedicated to their patients and the practice of Ophthamology.

In the coming months I will be telling you more about our practice, our services(cataract, glaucoma, crystalens, ophthalmic plastic surgery, including Botox, Restalyn and other fillers) and our staff.

I look forward to serving you.  Thanks, and talk to you soon.

Welcome to the Boston Eye Physicians & Surgeons website.  To tell you more about our practice and services, we have assembled pertinent information in an easy-to-navigate format.  We have a long history of careful patient care.  We open our doors to people of all ages, races, nationalities and gender.  We will be happy and proud to accommodate your special needs and problems.  Try us out.  Let us help you.

This is my first post!