Laser Vision Correction (Refractive Surgery)

If you are motivated to reduce or eliminate your dependence on glasses or contacts, you may be a candidate for laser vision correction, a surface procedure performed on the cornea to alter its shape and help it focus light clearly and accurately. At Hertzog Eye Center, your entire surgical consultation and screening process (to determine candidacy) is performed by your surgeon, Dr. Lars Hertzog. For patients determined to be good candidates, these procedures improve vision safely and precisely by reshaping the cornea. Most patients achieve 20/20 vision or better after surgery and no longer depend upon glasses or contact lenses to see clearly at a distance.

The cornea can be regarded as the “window” of the eye and acts as the major light-focusing structure of the eye. LASIK (laser-assisted in situ keratomileusis) is performed on the cornea to eliminate or reduce nearsightedness (myopia), farsightedness (hyperopia), and astigmatism. In the LASIK procedure, a very thin corneal flap is created and laid back, followed by application of Excimer laser energy to reshape the deeper corneal tissue. The flap is then laid back down, sealing into position within minutes. The result is a more accurately focused image within the eye, providing improved vision.

An alternative procedure for some candidates is PRK (photorefractive keratectomy). With PRK, the Excimer laser is applied directly to the corneal surface without creating an initial flap. Visual outcomes are excellent and similar to those achieved with LASIK, though healing will take somewhat longer.

Corneal Transplantation

The cornea can be regarded as the “window of the eye.” It acts as the major light-focusing structure of the eye by bending light accurately and directing it through the lens. The cornea must possess ideal shape and clarity to direct light accurately to the retina and produce clear vision. Glasses, contact lenses, laser vision correction, and cataract surgery can often be employed to achieve this. However, if the cornea is misshapen or cloudy due to disease, infection, or traumatic injury, corneal transplantation may be recommended by your surgeon to restore vision.

As a fellowship-trained corneal surgeon, Dr. Lars Hertzog is skilled in the use of several techniques of corneal transplantation. These entail the removal of only the central, diseased portion of a patient’s cornea and replacing it with clear, disease-free cornea from a human donor.

Traditional corneal transplantation (penetrating keratoplasty) involves full-thickness corneal replacement and requires several months of healing and visual rehabilitation. While very successful, patients may require the use of a contact lens to maximize vision following healing.

Patients with specific corneal diseases such as Fuchs’ Dystrophy or bullous corneal edema may be candidates for a more modern corneal transplant technique known as DSEK (Descemet’s-stripping endothelial keratoplasty). This procedure requires only the transplantation of the deepest, inner layer of the cornea, resulting in less post-operative astigmatism. Healing and visual recovery are accelerated, and patients rarely require a contact lens to see clearly.

Pterygium

A pterygium is a benign, wedge-shaped growth of the conjunctiva, which extends from the white of the eye onto the cornea. Symptoms include intermittent or chronic redness, foreign body sensation, and itchy eyes. While exact causes are unknown, pterygia are strongly associated with excessive sun exposure (ultraviolet radiation), dry climate, and dust, and are twice as frequent in men compared to women. Sunglasses, wide-brimmed hats, and artificial tears throughout the day may help prevent or limit the growth of pterygia. Surfers, skiers, fishermen, and other water-sport athletes are at particular risk and should wear eye protection that blocks 100% of ultraviolet radiation from the sun.

Small, infrequently inflamed pterygia can generally be treated effectively with topical medications and do not require surgery. On the other hand, a large pterygium may distort the central cornea (causing astigmatism), often with the risk of scarring. For pterygia that become vision-threatening or persistently inflamed, surgical excision is the definitive treatment.

Removing a pterygium from the ocular surface is a relatively straightforward procedure, though the risk of recurrent growth depends highly upon the surgical techniques employed. A skilled and methodical approach is necessary to reconstruct the ocular surface and provide a cosmetically acceptable outcome. As a fellowship-trained corneal surgeon, Dr. Lars Hertzog utilizes the modern techniques of conjunctival grafting and amniotic membrane transplantation necessary to minimize the risk of recurrent pterygium growth.

Dry Eye (Keratoconjunctivitis Sicca)

Dry eyes occur due to decreased tear production and/or increased tear evaporation. Symptoms include redness, burning, blurred vision, and “sandy” irritation. Paradoxically, patients often complain of watery eyes, a result of reflex tear secretion from the lacrimal gland in response to ocular irritation. Symptoms are worsened by activities in which the rate of blinking is reduced due to prolonged use of the eyes, including reading and computer use. Symptoms also increase in dry or windy environments and in proximity to heaters, air conditioners, or fans.

Most people with dry eyes experience mild irritation with no long-term effects. However, if the condition becomes chronic or severe, permanent damage to the ocular surface can occur, such as corneal scarring, which may impair vision.

Aging is associated with decreased tear production and is one of the most common causes of dry eyes, particularly in post-menopausal women. Other common causes include topical eye medications, systemic medications, eye infections, ocular surgery or trauma, and contact lenses. Systemic diseases such as diabetes, rheumatoid arthritis, lupus, Sjogren’s, Graves’, and Parkinson’s disease are also associated with dry eyes. Disorders of the eyelid can impair the blinking motion required to distribute tears and often need to be surgically corrected to prevent tear evaporation. Blepharitis is also frequently associated with keratoconjunctivitis sicca.

Treatment of dry eyes involves a variety of approaches depending upon the severity of the condition. In mild cases, rehydration with lubricating artificial tears or gels is often enough. A topical steroid may be prescribed for a brief period to treat inflammation. Topical Cyclosporine A (Restasis) may be prescribed long-term to increase tear production. Punctal occlusion (lacrimal plugs) is reserved for moderate to severe dry eyes when other medical treatments have been exhausted. Some studies have shown an association between dietary consumption of omega-3 fatty acids and improvement of dry eye symptoms.

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