Category Archives: General Eye Problems

What is the Best Eye Surgery for Astigmatism?

One of the most important aspects of a successful eye surgery is to make sure the patient is ideally matched with the procedure that is best for their specific vision problem.

Astigmatism is one of the most common vision problems that must be considered in any vision correction procedure.

What is astigmatism and how is it diagnosed?


Astigmatism is a very common problem, with almost everyone experiencing it to at least some small degree. In the past, eye doctors diagnosed astigmatism by refraction, which is when the patient is asked a series of questions (such as, “Which is better, 1 or 2?”) and the optometrist obtains a reading off of an instrument called a phoropter. A phoropter uses diopters as the unit of measurement, which provides readings in .25 increments. Using this older method, many patients are presumed to have no astigmatism at all. Thanks to advancements in technologies in recent years, we now use an instrument called an aberrometer, which is used to treat patients for Custom Wavefront-Guided LASIK. This instrument measures prescriptions in increments of .01 diopters. Aberrometry is ideal for objective and very precise measurements of astigmatism. Measured with this level of accuracy, it’s extremely rare to find a patient with 0.00 diopters of astigmatism. So,

1. Almost everyone has at least a little astigmatism

2. Astigmatism can be measured subjectively with a phoropter or objectively via aberrometry

3. LASIK corrects astigmatism

Which Surgeries are Most Common for Patients with Astigmatism?

When it comes to correcting astigmatism, the first line of defense, surgically speaking, is LASIK. This is because LASIK is effective for a wide variety of patients and offers the quickest recovery time. It is considered the “gold standard” for the surgical correction of astigmatism, so it’s the first option for those who are deemed LASIK candidates.

If LASIK is not an option, the primary backup plan is PRK surgery. While PRK works just as well as LASIK surgery at correcting wide ranges of astigmatism, PRK is typically Plan B simply because it includes the longer recovery time. If we find the cornea is not strong enough to make the flap necessary for LASIK, then we will likely offer PRK instead.

You can read more about LASIK surgery here and PRK surgery here.

What about Patients Who are not Candidates for LASIK or PRK Eye Surgery?

Phakic intraocular lenses are often used to correct nearsightedness in patients under 40 years old, as these patients still have the ability to adjust their focus (which is called accommodation). During this procedure, a lens is implanted inside the eye. In phakic IOL surgery, a lens is added, but the natural lens remains intact, which permits these younger patients to continue to be able to accommodate in order to see up close.

In the United States, phakic intraocular lenses currently are only approved and available to correct nearsightedness and are not available for the correction of astigmatism. Intraocular lenses used in cataract surgery, however, can correct astigmatism.

What about Intraocular Lenses Like the Ones Used in Cataract Surgery?

There are two types of patients who can have intraocular lens implants:

– Patients who have not yet developed cataracts and are candidates for a procedure known as Llear lens Exchange.

– Patients who have a cloudy crystalline lens in the eye and are thus candidates for cataract surgery where the natural lens is replaced with a synthetic one.

In cataract surgery, which is usually performed on patients 60 and older, the natural lens of the eye is replaced with an intraocular lens (IOL). IOLs for cataract patients that can correct astigmatism are called toric IOLs. Toric IOLs can also be used as part of an elective procedure called Clear Lens Extraction (CLE) or Refractive Lens Exchange (RLE), which is when the cataract surgery is performed in order to become eyeglass-free rather than to treat a cloudy natural lens. In CLE and RLE, the natural lens of the eye is removed and replaced with a synthetic lens.

Even though goals of CLE, RLE and cataract surgery are the same, i.e. the best vision possible, CLE and RLE are considered elective procedures, while cataract surgery falls into the medically necessary category.

Incisions on the Cornea to Correct Astigmatism

Sometimes, astigmatism can be treated during or after cataract surgery (or after an elective IOL procedure) by creating small incisions on the cornea. Corneal incisions for astigmatism can be called Limbal Relaxing Incisions (LRIs), Astigmatic Keratotomy (AK) or Arcuate Keratotomy (also AK). While a corneal incision procedure like LRIs and AK can be performed as a standalone elective procedure, it is most commonly performed in conjunction with either cataract surgery or a clear lens exchange. LRIs and AK can be performed as an adjustment after intraocular lens surgery when astigmatism is measured post-operatively, or it can be performed as part of the IOL procedure when the pre-operative astigmatism level indicates the need.

The difference between AK and LRI is simply the location of the cornea that is treated; LRIs are performed on a more peripheral part of the cornea. The two procedures provide similar results.

Astigmatism correction: What is next for you?

Woolfson Eye Institute (headquartered in Atlanta, GA, with nine locations around the Southeast) offers a wide variety of options for patients who require correction of astigmatism.

Our primary goal is to match each patient with the procedure that is right for them, whether that is LASIK, PRK, IOLs, or some other vision correction procedure.
No one should tell you exactly what surgery makes the most sense without providing a thorough eye examination. We encourage you to contact one of our offices today in order to schedule your complimentary consultation to see which procedure is right for you.

You don’t have to live with blurred vision due to astigmatism. Give us a call today and see why thousands of patients (including over 300 eye doctors) have chosen Dr. Woolfson for their eye surgery. Trust the Doctor the Doctors Trust! Contact us today!

Feeling Pressure In Your Eyes? Common Causes and Treatments

Sometimes our patients will say, “I feel like there’s pressure in my eyes or pressure behind my eyes.” Have you ever felt like this?

Many patients have, and we can help.

Ocular hypertension– What you need to know

Do you know that approximately 4.5% to 9.4% of Americans (age 40 or older) experience ocular hypertension?

Ocular hypertension refers to the situation when a person feels pressure inside the eye. This intraocular pressure is higher than normal when patients describe pressure behind or inside of the eye.

If this condition is left untreated, the high eye pressure can cause glaucoma, as well as permanent vision loss. On the other hand, some patients may feel ocular hypertension without damaging their eyes or vision.

A comprehensive eye exam or a visual field test can determine your ocular pressure. There are no outward signs or symptoms that will indicate ocular hypertension. You must see your doctor.


? Why do patients feel pressure inside of the eyes?

eye-square
Pressure inside of the eyes is part of a disease process called glaucoma. Glaucoma is when the pressure builds up in the eye and that causes gradual decline in the patient’s vision.

When patients have pressure in their eyes, it’s very rare that it would actually be pressure inside the eye. More typically that has to do with pressure around the eyes.

Let us explain.

The eyes are surrounded by a bony structure called the orbit, and surrounding the orbit is the sinuses. You have sinuses below your eyes and above your eyes. So when people feel pressure in their eyes, it is typically pressure in the sinuses surrounding the eyes.


? What causes eye pressure? What are the risks for elevated eye pressure?

The following list consists of factors that cause or are associated with ocular hypertension– they are virtually the same as the causes of glaucoma, as well.

  • Excessive aqueous production: This is the clear fluid produced in the eye. With too much fluid production, a patient will feel pressure in the eye.
  • Inadequate aqueous drainage: If the fluid drains slowly from the eye, this can cause increased eye pressure.
  • Eye trauma
  • Certain medications: Ocular hypertension is a side effect of certain medications (i.e. steroid eye drops, etc).
  • Other eye conditions
  • Race, age, and family history

? What should you do when you’re feeling pressure behind the eyes?

  • An easy way to look into this problem is to see your doctor for diagnosis and treatment.
  • Another way is to take a decongestant. If you have pressure in your eyes and you want to determine if it’s pressure around your eyes in your sinuses, a decongestant is a good way to resolve sinus pressure.

What should you do next? Seek treatment from qualified doctors.


! How to treat pressure inside or behind the eyes

In most cases it’s one or two eye drops a day to treat glaucoma and ocular hypertension. If eye drops are ineffective, we may recommend glaucoma surgery to treat high eye pressure.

If you are experiencing high pressure behind or inside your eyes, call Woolfson Eye Institute to schedule your appointment.

Surgery to Replace Reading Glasses: Does it Exist?


Around the age of 40, people begin to experience blurred vision when reading or looking at a computer screen. No longer can you adjust focus and see things close up. This only gets worse as you get older, until you are 60 and have no ability to focus. But is it possible to fix near vision and replace reading glasses with surgery or other options?

You probably know about LASIK surgery and its ability to correct eyesight. But what you may not realize is that most patients who move forward with this treatment are nearsighted, meaning they have poor vision far away and can see reasonably well up close.

When we, at our Southeastern laser correction centers, tell people 40 or over that even if they have LASIK surgery, they will still require reading glasses when looking at a computer screen or anything closer, he or she is often surprised and disappointed.

But guess what? There actually are ways to address near vision, with or without LASIK.

Monovision contact lenses

Monovision contact lenses are one option for correcting near vision, or presbyopia. When people wear these lenses, one contact lens gives them far vision, and the other lens gives them near vision.

Monovision LASIK

Most corrections that can be done with contact lenses can also be done with LASIK. This is true for monovision.

When patients come to us at Woolfson Eye Institute, and they have not had monovision lenses, we typically connect them with a trusted eye doctor in the community who can, at least temporarily, fit them with monovision contact lenses.

This way patients can make sure they are satisfied with one eye seeing near and one eye seeing far. They can go out in the real world and drive or hike or whatever they normally do to see if this type of vision works for them.

We take this step to better serve our patients because monovision is not for everyone. People who are avid tennis players or golfers most likely won’t be candidates for monovision. Neither will anyone who wants their depth perception to be as good as possible.

But don’t worry. Other options exist for people who don’t want monovision.

Do eye exercises or surgery to repair adjustable focus work?

reading glasses eye chart from Atlanta's Woolfson Eye Institute
In a perfect world, we would be able to show our patients some eye exercises, and they would be able to get their near vision back. But, unfortunately, this isn’t possible.

Research has shown that eye exercises cannot alter the eye’s basic anatomy or eliminate near vision problems. Nobody escapes presbyopia.

Surgery to repair the focusing system that breaks down has not been adequately successful to achieve FDA approval. There have been several unsuccessful attempts to use implants or other surgical procedures to restore adjustable focus for people over 40.

So, what does work?

Intraocular lenses or accommodating intraocular lenses

People with cataracts can choose to have a lens with built-in distance and near power. Bifocal Multifocal Intraocular lenses are similar to bifocal or multifocal contact lenses, both of which do a good job of delivering both near and distance vision.

But what if you don’t have a cataract? We actually don’t have to wait until a patient has a cataract. These lenses can be used as an elective procedure.

Another similar technology is accommodating intraocular lenses. These lenses provide a small degree of adjustable focus, which sometimes can provide near vision comparable to what people had when they were in their 30s or 40s.

However, these lenses are not always ideal for delivering excellent near vision, so they tend to be used less frequently than multifocals and monovision.

Corneal inlays

Recently, a procedure — comparable to LASIK — called corneal inlays has been in development. Imagine a flap or pocket being made in the cornea and a lens inserted to provide near vision. This technology is under development and not yet FDA approved, although there is some optimism that one of these corneal implants will be available soon.

One type of corneal inlay is called the KAMRA. These inlays take advantage of an optical principle called the pinhole effect. By looking through a small aperture, essentially an artificial small pupil, near and distance objects are both in better focus. Squinting improves your vision via the exact same property. This type of inlay, we hope, will be available in the next few months, and we expect to offer it at our laser correction center.

Imagine turning back the clock for your eyes to when you were 40 and didn’t have to wear reading glasses. This could be a reality very soon.

Woolfson Eye Institute can help you see better and even replace your reading glasses

At Woolfson Eye Institute, with offices in Georgia, Tennessee, and North Carolina, we want to give you the vision you deserve. That’s why we offer monovision and intraocular lenses and are seeking newer treatments for people who want to see up close again without glasses.

If you have questions or want to visit one of our centers, click here to find a location near you and to contact us about setting up an appointment.

This website provides general information & a list of our services. The information on this website is solely meant to assist you in your search for an eye specialist. You are urged to seek the advice of an eye specialist before undergoing any eye procedure. This site is intended for use only by healthy adult individuals. Any information on this website is not to be used as a substitute to seeking medical advice.