Andrew Ruzich, M.D. is on staff to provide consultations for specialty medical eyecare and eye surgery. This includes but is not limited to:      No-stitch cataract surgery with intraocular lens implants       Laser surgery for glaucoma and diabetes      Eyelid procedures

Cataract surgery and lens implantation

An intraocular lens, commonly called an IOL, is a tiny lightweight clear-plastic disk, which is placed in the eye during cataract surgery to replace the eye's natural lens. This is done with the best technique of phacoemulsification and no-stitch microsurgery. The eye's normally clear, natural lens allows light to pass through and focus on the retina. When a cataract forms the lens becomes cloudy, and light can no longer pass freely through it. The only way to remove the cataract is to remove the lens itself.

Can I see without a lens?
	No, the eye cannot focus properly without a lens. To restore focusing power after cataract surgery, cataract glasses, a contact lens, or intraocular lens must be substituted. Rarely, an IOL cannot be inserted, but 95 percent of the people who have cataract surgery have an intraocular lens implant.
What are the advantages of an IOL lens implant?
	An IOL implant is permanent. And, unlike cataract glasses which magnify images, an IOL produces a normally-sized and clear image on the retina, replacing the focus power of the natural lens more closely than either cataract glasses or contact lenses.
What are the risks?
	Today's implants are quite safe. But with any surgery complications can occur. There is always a possibility of hemorrhage, infection or vision loss during eye surgery. Dr. Ruzich will discuss potential complications with you.
How will an IOL affect my vision?
	An IOL cannot adjust its focus for both close and distant vision like the eye's natural lens does. With the help of an ultrasound test (An A-scan) and the computer, Dr. Ruzich can determine the general focusing power of the IOL before surgery. Although distance vision is usually quite good, bifocal or reading glasses are often necessary for close work. Most people experience a return of 20/40 vision - good enough to obtain a driver's license - shortly after surgery, but the results can never be guaranteed. Your postoperative vision depends on the health of the eye. If there are changes in the retina from aging or other conditions, vision will not be perfect even though the surgery was successfully performed.
Where will the lens be placed?
	The most popular placement site today is behind the iris in the posterior chamber where the eye's natural lens is located. When removing the clouded lens, your ophthalmologist will leave behind the lens outer membrane or capsule. The intraocular lens is placed in the pocket formed by the emptied lens membrane and inserted in place by a pair of loops.
Laser surgery for Glaucoma
	Glaucoma, which usually shows no symptoms until after considerable harm is done, damages the optic nerve after a buildup of pressure within the eye. Annual screening tests are recommended for Caucasians beginning at age 50, and for African-Americans starting at age 35. If detected in the early stages, glaucoma can be effectively treated to prevent loss of vision. Laser eye surgery for glaucoma is usually indicated if medical eyedrops fail to control the condition.
There are three types of laser surgery for glaucoma:
	Trabeculoplasty uses a laser to place "spot welds" in the drainage area of the eye - also known as trabecular meshwork - that allows the aqueous to drain more freely.  Iridotomy uses a laser to make a small hole in the iris - the colored part of the eye - which allows the aqueous to flow more freely out of the eye so the iris doesn't plug up the trabecular meshwork. Cyclophotocoagulation uses a laser beam to freeze selected areas of the ciliary body - the part of the eye that produces aqueous - to reduce the production of fluid.
Laser surgery for Diabetes
	Diabetic Retinopathy is a condition in which the small blood vessels in the eye can become blocked or leak causing tissue damage to the retina, resulting in loss of vision.  A patient with diabetes has a twenty five times greater chance of developing serious eyesight problems than a non-diabetic.   Diabetic patients need to pay close attention to their overall health to maintain vision clarity and the health of their eyes. Two essential steps in eyesight preservation are metabolic control--keeping glucose levels within the acceptable range, and, control of hypertension--keeping blood pressure down. Retinopathy is managed by either focal or peripheral laser treatments to the eye. Photocoagulation of focal diabetic maculopathy, before treatment, (left), after treatment, (right) Focal laser treatments - A laser beam is used to treat localized swelling and to reduce leakage from blood vessels. Peripheral laser treatments - When retinal tissue becomes ischemic (requires more oxygen), new blood vessels form to meet the demand. These new vessels are fragile and are subject to leakage and hemorrhage, causing vision loss. Pan-retinal photocoagulation laser treatments are used to control bleeding and to reduce the amount of oxygen the retinal tissue demands.
Eyelid procedures
	The most common eyelid abnormalities are those of eyelid positioning. Sometimes the eyelids can assume an outward or inward turning of the lids. This can cause irritation to the eye in the form of burning, scratchiness (foreign body sensation), redness, and tearing.  Managment consists of oculoplastic (surgical) repositioning of the eyelids to alleviate symptoms. Ptosis (drooping of the upper eyelids) can cause blockage of one's vision and is displeasing cosmetically.  Raising the eyelids using surgery (blepharoplasty) allows for normal function.
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	Phacoemulsification - The process by which a cataract is removed from the eye. An instrument is introduced through a small incision.  The cataract is reduced to fragments by ultrasound.  The fragmented cataract is removed by aspiration.  This process allows for a smaller incision than would be needed to remove the cataract if it were intact. No-stitch microsurgery - The surgery used for phacoemulsification.  The small incision allows the procedure to be performed as an out patient and therefore does not require a hospital stay. Healing is much faster and the incision is so small that no stitches are required.