Diagnosis and Treatment of Dry Eye

Diagnosis of Dry Eye

The diagnosis of dry eye is usually a clinical diagnosis.  This means it is diagnosed often by the symptoms you report.  At the Eye Surgery Institute, Dr. Stanley Grandon, Dr. Cindy Wang and I will take a complete history of your symptoms.

If you have dry eye you may often complain of burning, irritation, a foreign body sensation and /or fluctuating vision.  The vision may blur up when you are reading, using your cell phone or on the computer for a long time.

I will perform a comprehensive eye examination including using various dyes to assess the surface of the eye.  There are various other tests that can also be used to evaluate the quality of the tears in your eyes.

Treatment of Dry EyeDry Eye diagnosis and treatment | Eye Surgery Institute| Dearborn MI | Alaina Kronenberg MD

If your dry eye signs and symptoms are mild, I may recommend over the counter artificial tears to start.  The artificial tears in a bottle (with preservative) can be used up to four times a day.

If necessary, I may recommend preservative free artificial tears that can be used more often.  Preservative free tears may also be better if you are also on other drops for glaucoma.

For more moderate signs and symptoms of dry eye, I may also add a gel or night time eye ointment.  I may also recommend a prescription dry eye medication called Restasis.  Restasis can take several months to assess if it is helping you.

Other remedies for dry eye can include punctal plugs.  This is when the opening of the tear duct (called the punctum) is partially blocked with a tiny insert.  This will allow your natural tears or artificial tears to stay on the surface of your eye longer.

Blepharitis, Dry Eye and Ocular Allergies

If you have dry eye you may also have other associated problems that are contributing to your discomfort.  I will examine your eye for inflammation of the eyelid margin which is called blepharitis.  I will also assess for ocular allergies.  These conditions need to be successfully treated to achieve ocular comfort.

Goal

When I treat you dry eyes, it is necessary to be patient.  I usually tell my patients that “the problem did not happen overnight and it will not be better by tomorrow morning.”  Also, it is important to remember that the is no cure for dry eyes.  My goals are to treat you so that your feel at least 80% better over time.  If you are suffering from burning, irritation, foreign body sensation and /or fluctuating vision give us a call for an appointment as other ocular problems can also cause similar symptoms at  313-582-8856.
Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


Diabetes and the Eye

Diabetes and the Eye

In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes.  According to the American Diabetes Association, 1.4 million Americans are diagnosed with diabetes every year.  At the Eye Surgery Institute we recommend a dilated eye examination at least yearly in all diabetic patients regardless of symptoms.

Diabetes can affect the whole body, including the eye.  The eye disease is called diabetic retinopathy. Diabetic retinopathy is one of the leading causes of preventable blindness.  It is the leading cause of blindness among working adults.  Controlling your blood sugar can prevent and/or delay the onset of the effects of diabetes in the eye.

Regular dilated eye examinations are very important to screen for and detect the effects of diabetes in the eye.  Early diagnosis and possible treatment are essential for diabetic patients to maintain their vision.

Diabetic RetinopathyDiabetic retinopathy | Alaina Kronenberg MD

Diabetic retinopathy occurs when the normal blood vessels in the back of your eye start to leak.  This occurs from high blood sugars.   Diabetic retinopathy occurs in stages from mild to moderate to severe and then to proliferative.

Proliferative diabetic retinopathy is the most advanced stage. Tiny, fragile, abnormal blood vessels grow and can rupture and cause bleeding into the eye.  Sometimes, scar tissue can develop that can contract and possibly cause a retinal detachment.

Diabetic Macular Edema

The macula is the area in the back of your eye that provides your central vision.  Diabetic macular edema occurs when fluid builds up in the macula.  This can cause distorted or blurry vision.  Diabetic macular edema can occur at any stage of diabetic retinopathy.

Diagnosis

The effects of diabetes in the eye are diagnosed with a comprehensive eye examination including checking the visual acuity, dilation to evaluate the back of the eye (retina) and often an OCT image of the retina.  Depending on necessity, other tests may be recommended also.

At the Eye Surgery Institute we commonly use a fluorescein angiogram to help detect the signs of diabetic retinopathy.

Treatment

Diabetic retinopathy and macular edema can be treated with injections into the eye and /or laser treatment.  Often it needs to be treated with multiple treatments over time.  It is important to maintain good control of your sugars to decrease the effects of diabetes in the eyes.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


How to Diagnose and Treat Glaucoma

How to Diagnose and Treat Glaucoma

How do I diagnose and treat glaucoma?  Glaucoma has no symptoms.  Patients who come into my office for an eye examination or urgent eye problem are always tested for glaucoma.  To diagnose glaucoma, I check the patient’s intraocular pressure (IOP) and look into the back of their eye at their optic nerve during a dilated eye examination.

Diagnosis of GlaucomaTreat glaucoma | Alaina Kronenberg MD | Dearborn Michigan

Many patients with glaucoma have a normal eye pressure but have an optic nerve that looks suspicious for glaucoma.  If you have either an elevated eye pressure or a suspicious looking optic nerve, I will recommend more detailed testing including a visual field test, a picture of the optic nerve and checking the thickness of the cornea (pachymetry).

I may ask you to return to my office on another day to recheck the intraocular pressure, often at a different time of the day.  Eye pressure can vary day to day and different times of the day.

Treatment of Glaucoma

Depending on your intraocular eye pressure, appearance of the optic nerve and glaucoma testing, I may opt to treat you for glaucoma.  The initial treatment for glaucoma is often a once daily drop from the class of medications called prostaglandin analogs.  These drops are typically used at nighttime.  I will usually bring you back to the office a few weeks later to assess if the medication is working properly.

Some patients may need more than one drop to sufficiently lower their intraocular pressure.  Drops are usually added one at a time to assess their response.  Many patients may prefer to not take more than one medication, have difficulty affording or instilling the medications or the medications are not working enough.  For these patients, an in office laser procedure can be considered.

After the intraocular pressure has been sufficiently lowered, I will often recommend follow up in 3-4 months depending on the severity of the disease.  I will monitor the intraocular pressure and the testing will be repeated usually yearly.  If I feel the disease is progressing, I will add or change the treatment plan.

If your glaucoma cannot be sufficiently controlled with medical therapy or laser treatment, surgery is often considered.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


Risks and Benefits of Cataract Surgery

Possible Benefits of Cataract Surgery

Most people develop a cataract as they age.  Cataract surgery is indicated when you feel your day to day activities are limited due to poor quality vision.  Many patients notice trouble with driving initially when a cataract begins to interfere with their vision.  You may notice improvements in some of the common symptoms of cataracts listed below:risks and benefits of cataract surgery

  • to improve the quality of your vision
  • to decrease halos
  • to decrease glare
  • to decrease light sensitivity
  • to improve contrast sensitivity
  • to improve night vision
  • to make images brighter/less dull
  • to decrease dependence on glasses

Risks of Cataract Surgery

In general, cataract surgery is a relatively low risk surgery to your overall health.  Most patients have successful cataract surgery with no complications.  No surgery is free of possible risks.  The possible risks of cataract surgery are primarily within the eye.  These risks include but are not limited to the items listed below.

  • risk of an eye infection
  • risk of needing a second operation to completely remove the cataract, possibly performed by the cataract surgery or possible performed by a retinal surgeon
  • risk of swelling in the central vision (cystoid macular edema)
  • risk of swelling of the cornea that may be persistent
  • risk of a retinal detachment
  • risk of a leaky wound
  • risk of blindness (rare)
  • risk of needing to exchange the lens implant
  • risk of needing glasses for distance, intermediate and near activities after surgery
  • risk of halos and trouble driving at night especially if certain implants are used
  • risk of difficulty tolerating the difference in the glasses prescription between the two eyes, especially if surgery is intended on only one eye

Dr. Stanley Grandon and I will have a lengthy discussion with you regarding the potential risk and benefits of your cataract operation.  We will spend the time necessary to answer all of your questions.  You will need to sign an informed consent prior to your cataract surgery.

If you have additional questions or concerns about the risks and benefits of cataract surgery feel free to leave a comment.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


What to expect with cataract surgery

What to expect with Cataract Surgery

Now that you are ready to have cataract surgery what can you expect?

Cataract surgery is an outpatient operation often performed at ambulatory surgical centers.  Dr. Stanley Grandon and I perform ours at the Dearborn Surgical Center. cataract surgery

Preparation for Cataract Surgery

We ask you to instill drops for the 3 days prior to your surgical date.  One of the drops is an antibiotic and the other is an anti inflammatory drop.  You typically cannot eat or drink for several hours before the operation.  When you arrive at the Dearborn Surgical Center, we ask that you bring a driver with you.

When you arrive at the surgical center you will be asked to change into a gown.  You will receive medication to dilate the pupils and be seen by the anesthesia staff.  During the operation you will feel no pain.  You will receive sedation to make you comfortable.  In most cases, surgery is performed without a numbing injection.  Surgery usually takes less than 20 minutes.

After your Cataract Surgery

After your cataract surgery you can expect the vision to be a bit blurry as the eye heals and adjusts.  Most of the time cataract surgery does not require a bandage.  It is normal to feel a scratchy or foreign body sensation in the eye.  Dr. Stanley Grandon and I will have you continue the antibiotic drop, the anti inflammatory drop and we will add a steroid drop.  It is very important to continue to use these drops as directed after your operation for the eye to heal properly.

Post Op Visits

You can expect to come in for a check up to our office the day after your operation.  We ask you to bring your drops with you for that visit.  Most day to day activities can be resumed immediately.  You will then return to our office approximately one week after your operation and then at one month.  If necessary, we can perform surgery on your other eye 1-2 weeks after the first eye as long as the first eye is healing well.  A prescription for new glasses (if necessary) will be given at your one month post op visit.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


Cataract Evaluation

Cataract Evaluation

If you have been previously diagnosed with a cataract or if you feel you are experiencing blurry vision, a comprehensive eye examination is important.  The examination can determine if the cataract is the source of your visual complaints.  If the cataract is the source of your complaints, we can complete a cataract evaluation and discuss with you the option of cataract surgery.

Most people develop a cataract as they get older.  Cataract surgery is recommended when the cataract is interfering with your day to day activities.  Patients may experience difficulty driving especially at night or in the rain and bright sunlight.

Examination

A comprehensive eye examination involves checking your visual acuity, refracting to see if new eyeglasses can improve your vision, a slit lamp examination and a dilated examination.  Dr. Stanley Grandon and I will also take a comprehensive medical history.  This is done to assess for any conditions that would increase the risk of a problem during cataract surgery.

If  the cataract if the cause of your visual complaints, Dr. Stanley Grandon and I will discuss with you the risks and benefits of cataract surgery as part of the cataract evaluation.  We will take the time to discuss implant options with you.  For example, if you have astigmatism you may be a candidate for a toric implant to correct the astigmatism.  If you have a desire to be less dependent on glasses for near activities, you may be a candidate for a presbyopic implant that allows some vision for near and intermediate activities.

Scheduling Cataract Surgery

If you decide to schedule the cataract operation, we will take measurements to determine the implant type and power to use.  The entire cataract evaluation can take approximately 2 hours time.  You will read and sign informed consent paperwork.  Our surgical schedulers will provide prescriptions for drops to be used before and after cataract surgery.  They will go over all of the details of what to expect the day of your operation.  You will need to have a driver bring you to the Dearborn Surgical Center on the day of your surgery.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


I am a runner

Running

I am a runner.  I haven’t always been a runner, but in the last few years I have enjoyed running more and more.  I have found that as I get older, it’s easy to keep in shape and eat the desserts I love if I exercise.  The easiest way to exercise with a busy work schedule is to literally run out the door of my house.  It’s a little tougher for me in the wintertime as I’m confined to the treadmill or running in the cold and often on snow and ice.boston marathon

Running fits just fine into my family life as I can go early in the morning and it doesn’t interfere with my kid’s hectic schedules.  I guess you can say that I’m addicted now, but there are plenty worse things to be addicted to.  I love it and I have made new friends running.  I enjoy spending time with these friends on our early morning runs.

Boston Marathon

Without realizing it, I continued to get stronger and faster.  Over the years I had run many half marathons.  I finally decided to run my first marathon 3 years ago and I since have qualified for the Boston marathon.

Running a marathon is a much about mental toughness as it is about physical capabilities.  No matter how prepared your body is for the race, you need to keep your brain from wanting to quit when you start to hurt.

The Boston marathon is the premier marathon and requires all runners to qualify to be able to participate.  Some people try all their lives to get in.  Qualifying for the Boston marathon is a source of personal pride.  I have run the race in 2015 and 2016.The energy there is intoxicating.  Everyone is so happy to be there and is so open to sharing their experiences.  The personal stories are incredible.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


What is a Comprehensive Eye Exam?

What is a Comprehensive Eye Examination?

You may wonder what is the difference between a comprehensive eye exam and an exam for prescription eyeglasses?  When I go to get a prescription for new eyeglasses did I have a comprehensive eye examination?

A full eye examination starts with the doctor checking your vision.  Then, the doctor will perform a refraction.  This is when the eye doctor tries to see how good you can see with eyeglasses.  The eye doctor wants to know how good you can see with a pair of eyeglasses.  An eyeglasses examination may often end now.

Comprehensive Eye Examcomprehensive eye examination

A comprehensive eye examination includes many other aspects to check the health of your eyes.  Diseases of the eye such as glaucoma, cataracts and macular degeneration (ARMD) will not be detected on a glasses examination.

A comprehensive eye examination includes a eye pressure check to assess for glaucoma, a slit lamp examination as well as dilation of the pupils.  Dilating the  pupils allows the doctor to again check for glaucoma, to check for cataracts, macular degeneration (ARMD) as well as many other diseases of the eye.  Many cases of glaucoma can be missed if the pupils are not dilated.  An eye examination can take an hour or more.

It is especially important to have a dilated eye examination if you have diabetes or a family history of eye diseases.  Many causes of preventable blindness have no symptoms, especially at the early stages.  Depending on your age, recommendations for complete eye examinations vary, but many of our patients are seen on an annual basis.  We all want to see for the rest of our life!

Board Certified Ophthalmologist

A board certified ophthalmologist will typically perform a comprehensive eye examination to make sure your eyes are healthy.  If any diseases of the eye are suspected, they may decide that further in depth testing is indicated.  This testing can help the doctor determine the severity of the disease and if any treatments are indicated.  The doctor will let you know how often follow up evaluations are indicated.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126


How to Choose the Best Eye Doctor

How to choose the best eye doctor for me?best eye doctor |ophthalmologist|Alaina Kronenberg MD

Different patients have many different reasons for choosing an eye doctor.  How do you know who is the best eye doctor for you?  Things to consider are the doctor’s experience in treating the conditions you have or are concerned about.  It is important to review the eye doctor’s credentials.  Are they a board certified eye doctor?  Are they an ophthalmologist (medical doctor) or an optometrist?  You want to know how long the doctor has been practicing and their years of experience in treating particular conditions.

If you are considering a surgical procedure such as cataract surgery, LASIK or EPI-LASEK you want to know  how many of these procedures the doctor performs and how many years they have been doing this procedure.

Communication

Does the eye doctor have a good bedside manner?  It is important that your eye doctor spends the appropriate time to examine your eyes and to answer all of your questions.  Sometimes it is helpful to write down any questions before your appointment so you do not forget to ask a particular question.

Credentials

You want to make sure that your ophthalmologist is board certified.  It may be helpful to learn more about your doctor such as where they went to medical school and did their residency training.  You can look for reviews for your doctor online also.

Office

It is important to ensure the office staff is friendly and welcoming.  You want to ensure they are willing to assist with any insurance or prescription issues.  It is helpful to ask what days and hours the doctor is in the office and make sure it is convenient with your schedule.

You may want to ensure the office is close to your home or work.  Does the doctor usually run on time?  It is important to investigate how much time you can expect to wait for an average appointment.

Do you like your doctor?

It is important that you feel comfortable with your eye doctor and that they treat you with respect.  You want to make sure they are willing to listen to and address all of your concerns.  If you want to share how you choose the best eye doctor please leave a comment below.

Alaina Kronenberg, M.D.
Cataract Specialist
Comprehensive Ophthalmologist
Dearborn, Michigan 48126