Comprehensive Eye Care
The visual system is a complex network that includes the eyes, eyelids, orbits (eye sockets), extra-ocular muscles, cranial nerves, and the vision center of the brain. Good vision can only result if all these parts are working together in harmony. At nces, our goal is the health and preservation of your vision through the continued maintenance of this visual system. With that mission in mind, we offer a comprehensive range of eye care services. Those services include annual adult and pediatric exams, glasses and contact lenses, as well as the medical and surgical management of common (and not-so-common) eye conditions. Among the medical conditions we see on a daily basis include:
Droopy eyelids and other lid malpositions
Conjunctivitis (Pink eye, red eye)
Diabetic eye disease
Age Related Macular Degeneration
Glaucoma and Ocular Hypertension
Thyroid Eye Disease
Visual conditions related to stroke and other neurologic disorders
Cosmetic Eyelid Surgery & Non-Surgical Eyelid Rejuvenation
Many people wish they could turn back the clock to achieve a more youthful appearance. Over the years, numerous research studies have revealed that those individuals who seek out procedures to look younger and less tired often experience a positive psychologic effect as they improve their self-confidence and self-esteem. More recent studies have demonstrated the critical role of the eyelids, brows and the forehead as indicators of age and fatigue. Dr. Berger has sub-specialty training in cosmetic eyelid plastic surgery an rejuvenation procedures.
For most individuals in their mid 30’s to mid 50’s, non-surgical rejuvenation procedures can be performed in the office to achieve a that more youthful appearance. Botox can be used to achieve a non-surgical brow lift and get rid of the creases and frown lines that form on the outside corners of the eyes, on the forehead, and in between the eye brows. In addition, dermal fillers, like Juvéderm® or Restylane®, can be used to erase the dark circles under one’s eyes.
Laser resurfacing can be performed on the lower eyelids to wipe out those fine wrinkles that cannot be addressed by Botox or dermal fillers.
For individuals with heavier eyelids or brows, surgical correction is often required. Dr. Berger performs cosmetic eyelid lifts (upper and lower lid blepharoplasties) and brow lifts in the operating room. For upper lid blepharoplasty the excess skin and fat are removed with no visible scarring since the incisions are made within the natural creases of the eyelid. For lower lid blepharoplasty, the incision is made either on the inside of the lid, or just below the lash line, so that no visible scar is apparent. Laser resurfacing is often done in conjunction with a lower lid blepharoplasty to augment the appearance of youth.
The eye works in a very similar manner to a camera. In a normal healthy eye, the crystalline lens sits immediately behind the iris and serves to focus an image onto the retina in the same way that a camera lens focuses an image onto the film. A cataract is a clouding of the normally clear crystalline lens. Cataracts can develop at any time of life and at variable rates, but in most people they tend to develop with age, usually in one’s 60’s or 70’s. Because age-related cataracts usually develop slowly, people often don’t notice how they affect their vision until they start to experience visual compromise with their daily activities, like reading or driving. Symptoms may include any or all of the following:
Blurred or clouded vision
Glare and sensitivity to bright lights
Increasing difficulty with night vision
Difficulty with reading, either due to blurred vision or need for brighter light
Dulling of colors
More frequent changes in glasses prescription
Once a cataract starts to affect one’s activities of daily living, cataract surgery is likely going to be necessary. Surgery generally takes 15 to 25 minutes and is performed under light sedation with a local anesthetic. Our surgeons use the most advanced technology through a small incision at the edge of the cornea. This process is known as phacoemulsification, which uses high frequency ultrasound to break up the cataract into small pieces. The cataract is then aspirated through a vacuum port, and a clear lens implant (intraocular lens, aka IOL) is put in its place. This lens implant is made out of acrylic and helps to focus light more sharply on the retina. The incision in the cornea usually heals very quickly, and it is so small that it rarely requires any stitches. The vast majority of patients see significant improvement in their vision within a day. Patients can resume most of life’s daily activities within 24 hours.
In the process of replacing a cataract with a clear lens implant, we now have the ability to reduce an individual’s dependence on glasses. The standard lens implants focus one’s eyes for distance, and over-the-counter reading glasses will still be necessary for near vision. For those who have used contact lenses for mono-vision (one eye focused for distance and the other eye focused for near), the prescription can be set in each eye to match what was previously achieved with those contacts lenses. Toric lenses are available to counteract any significant astigmatism that a patient may have. For those individuals who want the best of all worlds, with no dependence on glasses for distance or near, advanced technology multifocal and accommodating lenses are available.
Eyelid Reconstructive Surgery
Dr. Berger sub-specializes in plastic and reconstructive surgery of the eyelids. Some of the procedures include upper eyelid lifts, as well as surgical and non-surgical lower eyelid rejuvenation procedures. In addition, he preforms surgical reconstruction for eyelid malpositions, excision and reconstruction for skin cancers of the eyelids, and surgical treatment for tear drainage issues.
Upper Eyelid Lift (Upper Lid Blepharoplasty)
As we age, the skin of the upper eyelid often becomes redundant and creates a droopy, wrinkled, and sometimes tired appearance. In some individuals this redundant skin can become severe enough that it impairs the outer and upper portions of their field of vision.
Blepharoplasty is a surgical procedure to remove the excessive eyelid skin and underlying tissue, leading to a more rejuvenated appearance and improvement of the peripheral vision. This procedure can be done for both cosmetic and functional reasons. It is preformed on an outpatient basis in a surgery center. An incision is made (in most cases using a laser) along the natural creases and folds of the upper eyelid, which allows your surgeon to hide the incision line so that it is not visible to you or anybody else once the healing process is complete. Swelling and bruising are expected for a couple of weeks after the surgery.
In cases where there is demonstrable evidence of impairment of the upper and out fields of vision, your medical insurance usually cover the procedure. Patients with private insurance often require pre-certification before the procedure can be done, but those with Medicare as their primary insurance do not require pre-certification.
Droopy Eyelid Surgery (Ptosis Repair)
In addition to redundant eyelid skin, the lid itself can be droopy. This condition is known as ptosis. Sometimes ptosis can be a congenital defect present at birth, but more often it is a result of aging, whereby the attachments of the muscle (known as the levator palpebrae superioris) that opens the eyelid become weak and attenuated over time.
The most common approaches to repairing a droopy eyelid entail tightening of the levator muscle, either through an external or internal incision. There are numerous other approaches to surgically repair a droopy eyelid. Only your eyelid plastic surgeon can determine which approach is most appropriate.
Skin Cancer of the Eyelid
Almost 10% of all skin cancers arise in the eyelids. Skin cancer in the eyelid is not something most people think about. The reason the lids are such a common area for skin cancer to develop is because they are often exposed to the sun. It is an area that people frequently forget to protect from the sun, either with sunblock cream or UV blocking sunglasses.
It is often difficult to differentiate benign eyelid lesions from malignant ones. Most health professionals (outside of eye care and skin care specialists) frequently glance over small lesions and ignore them with the thought that they are simple “skin tags.” The reality is that one can rarely predict the malignant potential just by looking at the lesion on gross exam. Most lesions should be biopsied and examined under the microscope by a pathologist. All too often, unfortunately, by the time a patient gets to an oculoplastic surgeon, the eyelid lesion is too large and requires more radical reconstructive surgery. If you have a lesion of concern on your eyelid, do not hesitate to make an appointment for a consultation in our office.
Tear Drainage Problems
Watering eyes is usually due to one of two issues: 1) Poor tear drainage, or 2) Overproduction and/or reflex watering. By far, the most common cause of watering is reflex tearing due to an unstable tear film. Patients will often give a history of the watery eyes occurring during visually demanding tasks, like reading, working on the computer, or driving. They also usually report that the tears “well up” in their eyes but rarely run down their face. This condition is usually treatable with over-the-counter methods or prescription eyedrops.
It is not uncommon, however, for the tear drainage duct to be narrow or totally blocked. In such cases, tear production is normal, but failure to drain at the inside corner of the eye causes watering to run down the face. Unlike reflex watering, symptoms of an obstructed tear drainage duct are constant and not associated with any particular task. Correction of an obstructed tear drainage duct can rarely be treated medically and usually requires surgery.
Other Eyelid Malpositions
Other problems that occur with the eyelid may include the following:
Inward turning lower eyelid (Entropion)
Outward sagging lower eyelid (Ectropion)
Eyelashes turning inward (Trichiasis)
Easily everted upper eyelids (Floppy eyelid syndrome)
Difficulty or inability to shut eyelids (Lagophthalmos)
Thyroid eye disease
The above-mentioned conditions are the most common ones seen on a day-to-day basis in an oculoplastic surgeon’s clinic, but there are volumes of other maladies that can occur with the eyelids. If you have questions or concerns about your eyelids or tear drainage issues, please call to set up an appointment for a consultation.