Macular degeneration is a condition in which the macula of the eye breaks down, resulting in a loss of vision in the center of the visual field. The function of the macula is to protect the eyes by absorbing excessive ultraviolet rays, thus acting like a natural sun block for the eyes. Today, macular degeneration is one of the leading causes of blindness in North America. The majority of people affected by macular degeneration are 65 or older. The macula of our eyes also contributes to our ability to drive, read, see colors, and recognize human faces. The retinal pigment epithelium is a tissue situated under the retina that may degenerate as we age. This degeneration may result in “wet” macular degeneration or “dry” macular degeneration.
Atrophic or dry macular degeneration is a common type of age-related macular degeneration. About 85-90% of macular degeneration cases consist of dry macular degeneration. When an individual suffers from dry macular degeneration, small yellow-colored deposits, known as drusen, can be seen between the layers of retina. These deposits lead to gradual and progressive reduction of central vision. Most people above the age of 50 have some level of drusen in their eyes. Drusen will not create any problem immediately, but it can be dangerous if the deposits become larger. If your eyes have drusen, then Dr. William Boothe will recommend that you schedule regular eye examinations so he can monitor the progression of your dry macular degeneration.
When dry macular degeneration progresses to a certain extent, it becomes known as “wet” macular degeneration. The abnormal growth of a newly formed blood vessel under the retina is known as wet macular degeneration. Wet macular degeneration is a more serious condition than dry macular degeneration. Fortunately, only 10-15% of macular degeneration patients suffer from wet macular degeneration. The newly formed blood vessels are known as neovascularization. The fragile structure of these abnormal blood vessels makes them break easily, thereby causing bleeding. The bleeding causes the macula to swell and can lead to scarring. Scarring of the macula causes severe and rapid central vision loss, which cannot be corrected through treatment.
LASIK treatment cannot cure macular degeneration, but it can slow down the process so that the condition does not progress in severity to wet macular degeneration. According to Dr. Boothe, LASIK procedure will help you preserve your remaining vision. With the help of LASIK, Dr. Boothe can stop the spread of abnormal blood vessel formation that can lead to wet macular degeneration. In order to be most effective, LASIK procedure should be performed at the early stages of macular degeneration. Dr. William Boothe will use LASIK to destroy newly formed blood vessels to prevent bleeding in the eyes. LASIK treatment can also be used in combination with other therapies, such as vitamin regimens, to improve the condition. Dr. Boothe will ask you to undergo a series of eye examinations so he can understand the extent of eye damage caused by macular degeneration and determine whether LASIK treatment will be effective and safe for you.
My husband and my friends had always encouraged me to improve my vision by laser eye surgery. It was a good idea and I was not against it. But I am a very busy person. I work from 8 am till 6 pm and in the evening I have a lot of work to do at home. I try to spend as much time as I can with my daughter and my parents. I had time for everyone but did not have time for myself. I was 14 years old when I wore my first glasses and my vision slowly got worse.
Last summer I met a former classmate by chance. It was very nice because during school years we always shared a desk. We went to a cafe and recalled the school years. She had poor vision like me but when I met her, she was without the glasses. I asked her how she got rid of her glasses. She told me about Dr. William Boothe and about the successful treatment at his center. She said that she was almost blind before but due to Lasik surgery she improved her eyesight and now sees perfectly without glasses. It was interesting to hear about it and I trusted her because she was a true example in front of my own eyes. She gave me the phone number of the center and suggested to call for a free consultation with Dr. William Boothe.
I called to Boothe Eye Care & Laser Center and a very pleasant girl offered me a few days and times when Dr. Boothe could have a consult with me. I was surprised when I found out that Dr. Boothe sees patients on the weekend it was a good fit for my schedule.
In the early morning, on Saturday, I arrived at Boothe Eyecare. I spoke with the receptionist and the assistant took me to do a few exams. Later I waited a short time (during this time I read some articles in ophthalmology magazines). Dr. Boothe seems to be a very calm, respectful and hard-working person. His assistant and other members of staff had very good manners. They were polite and made everything pretty easy. The center was clean and tidy. I never saw much of a crowd at the center, but I always went there .
Dr. William Boothe talked in details about the IntraLastik laser procedure and I agreed to have an appointment the next Saturday for my surgery. Before my operation I was a little scared. At the surgery I did not feel the pain I was afraid of, just high pressure on the eyes.
The next day I stayed at home. I could not believe that I see the little print with the names of spices without glasses. It was a wonderful day. On Monday I went to center to check my eyes after surgery. Dr. Boothe said that I had more than 20/20 vision. He wrote some prescriptions and explained how I have to take care of my eyes. When I came to work my colleague asked me whether I forgot my eyeglasses. “Yes, I did,” I answered, “I forgot about my glasses forever!”
I visited Boothe Eye Care & Laser Center two years ago. I had a consultation with Dr. Boothe and his assistant tested my eyes in the examination room. Dr. Boothe said that I have cataract in the right eye. He explained that the best treatment for me would be replacement of my crystalline lens with a new soft and flexible artificial lens. But I hesitated. I began to look for information about cataract. I gathered a lot of information and arrived to a conclusion that Crystalens is the best procedure to improve my vision. I looked for a good place to have the implant operation and my choice was Dr. Boothe’s Center.
I chose this center because:
1. Boothe’s Eyecare Center has a great number of positive reviews.
2. Precise allocation of time.
3. Surgery was performed quickly (from 15 till 30 minutes) and used their sophisticated devices.
4. The members of the staff are polite and take care of each patient.
5. The newest technologies are used at this center.
6. Everyone from Dr. Boothe to his assistant had high surgical skills and the experience to build strong relationships with patients.
I want to express my gratitude to Dr. Boothe for improving my visionWhen I stopped wearing glasses my life started to change. I see much sharper, even when compared with glasses (no more cloudy vision) and therefore my advice to patients is - do not hesitate!
An uncommon ocular chemical injury today is from a foreign body consisting of the “lead” from an indelible pencil. The leads in violet colored indelible pencils at one time contained 30% methylrosaniline chloride (methyl violet), graphite, and a binder such as gum tragacanth said Dr William Boothe. The offending chemical is the methyl violet, an analine dye, and protoplasmlie poison. Toxicity to the external eye is manifested by diffusion of deep purple stain, with chemosis, edema, and necrosis. This process is relatively rapid and may occur from only a small retained foreign body. The eye can be left severely impaired or blind, and therefore such an injury is a true ocular emergency.
Treatment involves using as much debridement as is practical. If stained tissue remains, 2% fluorescein solution is used to irrigate the affected tissues over a period of 12 to 24 hr. The reaction of the dye can be totally reversed with early treatment in Boothe Laser Center.
Methyl violet is a high molecular weight dye that easily dissociate", to form cations. In the cationic form, it binds anionic groups in tissues. Sodium fluorescein competes with the tissue anions to form a slightly dissoci-ated salt, thus leaching the toxin from ocular tissues.
Graphite pencil lead today consists of 70 percent graphite, 30 percent clay, and some additives such as spindle oil, liquid paraffin, and silicone oil. Intraocular foreign bodies of this type are relatively inert and can re-main symptom- free over long periods of time.
According to Dr. Boothe, since fluorescein diffuses through the tear film without layering out, it serves as an excellent adjunct in the fitting of both polymethylmethacrylate and gas-permeable contact lenses. Fluorescein distribution under the contact lens depends on the degree of steepness of the lens. An optimum fitting lens should exhibit a diffuse pattern in which fluorescein can be easily detected under the whole surface area of the lens. Collection of fluorescein in the center with absence of fluorescein in the periphery of the lens indicates an overly steep fit. If dye is concentrated in the periphery with none in the center, the fit is too flat. Staining patterns are best assessed using a cobalt filter. Obviously, other factors besides the staining pattern need to be taken into consideration when fitting a rigid contact lens.
Fluorescein should not be used to assess the fit of a soft hydrophilic lens. Soft lenses have pores of variable sizes, most of which allow rapid passage of fluorescein into the lens material. This absorption has the effect of obscuring the stained tear meniscus under the lens, making evaluation of the tear pattern impossible. Also, the hydrophilic lens becomes noticeably discolored for a period of several hours to days. Fluorexon should be used if examination of the lens-tear relationship is desired. In practice this assessment is rarely necessary for the fitting of a soft hydrophilic contact lens.
After fluorescein is used in the eye, replacement of a hydrophilic lens should be delayed for at least 1 hour. However, if thorough irrigation of the fluorescein solution is performed, the lens may then be replaced immediately.
Seidel’s test uses fluorescein to demonstrate the leakage of aqueous from the anterior chamber, explains Dr. Boothe. In 1920 Seidel suggested using 2% fluorescein to show that aqueous passed through the conjunctiva of filtering blebs after Elliot trephine operations. More commonly this technique has been used to demonstrate the presence and location of leaks after anterior segment surgery or penetrating trauma. With routine use of Seidel’s test during implantation surgery, Sinskey and co-workers had only two shallow anterior chambers in over 1600 cases.
When 2% fluorescein is applied to a leakage area, a bright green rivulet can be seen surrounded by yellow-orange fluorescein as viewed by white light. Leakage from a conjunctival flap may give a diffuse color change rather than a distinct rivulet. One should be aware that diffuse color changes may also be produced by tear dilution. A 10% solution for intation may be used to enhance contrast and provide a longer time for absorvation.
Havener states that the property of fluorescence is not, used is performing Seidel’s test. On the contrary, others feel that fluorescence can be a great help. The color change from yellow-orange to green occus because of dilution. When an adequate concentration of fluorescein is used, concentration quenching occurs. As dilution of the fluorescein or curs at the site of leakage, fluorescence markedly increases. Viewing this contrast under a cobalt light can make detection of a leak much easier than viewing by white light alone.
Detection of Foreign Bodies
Since fluorescein demonstrates surface irregularities, as demonstrated multiple times, by Dr. Boothe and other eye researchers, it is often useful in detecting corneal foreign bodies. Capillary action causes pooling around a partially exposed foreign body. When the foreign body has not epithe-lialized, there is often a staining ring surrounding it. If a foreign body is buried in the conjunctiva, the area of entrance overlying it is often stained. Fluorescein may be of considerable help in the meticulous search for alkali particles, which if left hidden in the fornices could cause extensive further damage.
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Dallas Lasik surgeon Dr. Boothe, Director of Boothe Eye Care & Laser Center, explains different vision correction techniques and procedures in his new blog.