Cataract and Lens Implant

At the WVU Eye Institute, cataract surgery is performed in our state-of-the-art same day surgery suite located within Ruby Memorial Hospital on an out-patient basis. A sutureless, or "no stitch", technique is employed to optimize rapid visual recovery. Following the 20-minutes procedure, an intraocular lens implant is placed in the eye so that the eye will focus properly. The patient can return to normal activity within a few days of the procedure

Comprehensive Eye Care

All children should have their eyes checked by age three. A family history of childhood vision problems, a wandering eye, crossed eyes, or other problems warrant earlier attention. Before the age of 20, as recommended by a pediatrician or other physician.

Between the ages of 20-40, every five years, unless there are visual changes, pain, flashes of light, new floaters or tearing, or if the eye is injured.

Between the ages of 40-64, every two to four years. Over age 65, every one to two years. African-Americans are at greater risk for glaucoma, and should have eye examinations every three to five years before the age of 40, and every two years after age 40.

Persons with diabetes are at risk for several eye disorders, including diabetic retinopathy, glaucoma, and cataracts. These individuals should have eye examinations every year.

Corneal and External Disease

Our practice has a fellowship trained subspecialist in cornea and refractive surgery, Dr. Lee Wiley. Dr Wiley provides both medical and surgical treatment of disorders that effect the external structures of the eye. The cornea is the clear dome shaped structure responsible for transmitting light into the eye as well as serving an important protective function. When misshaped and/or scarred, vision can be compromised.

In addition to performing laser correction for astigmatism, near sightedness and far sightedness, the doctors can also use the laser to correct certain scarring conditions.

Both partial thickness (lamellar) and full thickness (penetrating) corneal transplantation (keratoplasty) are performed in our institution on a weekly basis.

Dr. Wiley performs both standard small incision cataract surgery, and complex cataract cases such as dislocated lenses and mature cataracts. The doctors are often called upon to place secondary intraocular lens implants.

Medical aspects of the practice of cornea and external disease include the care of conditions such as dry eye, allergy, and infections of the eye. Dr. Wiley has a special interest in immunologic disease of the eye such as scleritis, iritis, corneal graft rejection, and peripheral ulcerative keratitis. Dr. Wiley participates in general eye care including exams for glasses, evaluation for cataract surgery and glaucoma screening.

Glaucoma

Glaucoma is an eye disease in which the optic nerve-which connects the eye to the brain and carries vision information to the brain-is progressively damaged, causing progressive loss of peripheral vision (side vision). In most cases, high pressure inside the eye causes the nerve damage. If untreated, glaucoma can lead to blindness, but with treatment, sight can be preserved. The goal of treatment is to lower the pressure inside the eye. Treatment options include eyedrops, laser therapy, or surgery.

Glaucoma services are provided by Drs. Judie Charlton and Tony Realini, both of whom are fellowship-trained glaucoma specialists. Our services range from advanced diagnostic technology-to determine which patients should receive glaucoma treatment-to cutting-edge laser and surgical procedures to lower the eye pressure to safe levels.

In addition, we have an active clinical research program in glaucoma. Many of our patients benefit by participating in clinical trials, in which they help expand our treatment options and receive medications and services at reduced or no cost. A list of our current studies accepting new patients is listed on our research page (hyperlink "research page" to the research page).

Both Dr. Charlton and Dr. Realini are currently accepting new patients, and referrals are only necessary if your insurance coverage requires one.

Medical and Surgical

This service involves both the medical and surgical treatment of retinal and vitreoretinal disease. The types of diseases treated include manifestations of local, systemic and genetic diseases as they affect the retina and vitreous.

The WVU Eye Institute houses state-of-the-art technical equipment used to diagnosis retinal disease. This equipment includes ultrasound, fluorescein angiography and electrophysiology. Treatment methods include laser therapy, cryotherapy, retinal detachment surgery and vitrectomy. The Retina Service performs more than 700 laser procedures each year while caring for patients with age-related macular degeneration and diabetic retinopathy.

Dr. Lionel Chisholm and Dr. Monique Leys are both retina fellowship trained. Dr. Chisholm focuses on the care of surgical retina patients while Dr. Leys cares for patients with medical retina diseases. Both physicians are accepting new patients, and referrals are only necessary if your insurance coverage requires one.

Neuro-ophthalmology

Neuro-ophthalmology is the subspecialty that involves the relationship between the eye and the brain, how the eye sends visual messages to the brain and how the brain influences the eye. Visual disturbances can result when the proper functioning of the optic nerve and its connections are affected by any of several processes such as stroke, inflammation, multiple sclerosis or tumors.

Dr. Brian Ellis, who completed an ophthalmology residency followed by a neuro-ophthalmology fellowship at the Cleveland Clinic Foundation, provides our neuro-ophthalmology services at the WVU Eye Institute. He is the only neuro-ophthalmologist in the state of West Virginia and has a special interest in the management of pseudotumor cerebri.

A neuro-ophthalmology exam is tailored to the patient's specific complaint. The initial office visit may last three hours or more due to the comprehensive evaluation of visual function, eye structure and related ophthalmic tests. It is important that new patients arrange to have the following information sent to Dr. Ellis at the WVU Eye Institute prior to their appointment or bring the information with them:

New patients are accepted by referral from another physician or optometrist.

Oculoplastic, Orbital, Lacrimal Disease and Surgery

This service deals with disease and surgery of the eyelid, the structures around the eyelid which are known as the orbit, and the tear drainage system, the lacrimal system. The position of the eyelid is vital to the health of the eye. Lid malposition can occur as people age or from other disease processes. The eyelid can become droopy, known as ptosis, the eyelid skin can become redundant, sometimes the eyelid can turn in or out. There are many names for lid malpositions, such as ectropion, entroption, ptosis, for example.

In these modern times, skin cancer has become a serious health threat. Skin cancer can occur in the eyelids and around the eye. Any discoloration, bump, or new growth on the eyelid should be examined by a eye physician. Especially worisome signs include bleeding, rapid growth, or destruction of the normal eyelid appearance. Oculoplastic surgeons like Drs. Linberg and Sivak specialize in tumor removal and reconstruction of the eyelid.

There are many diseases that affect the structures around the eyelid, in addition to the eyelid. The vast field of orbital disease and surgery encompasses problems like Graves orbitopathy, cancer, infection, and congenital and vascular malformations. Drs. Sivak and Linberg have special interest in inflammatory diseases of the orbit, like Graves disease, and they are doing clinical research involving new agents for the treatment of Graves orbitopathy.

Cancer and other diseases and malformations of the orbit can often involve surrounding structures, like the sinuses and brain. At West Virginia University, we have a sub-specialized team of neurosurgeons, head and neck surgeons, and interventional radiologists that work together on these complex diseases. Dr. Sivak is a member of this skull base team, and has experience not only in treatment of theses orbital processes but in reconstruction of the orbit as well.

Sometimes disease or trauma causes loss of an eye. Drs. Linberg and Sivak have extensive experience in enucleation and eviseration procedures. They work closely with the ocularist (Mr. Tillman) who makes prosthetic (glass) eyes for use after these procedures.

Trauma can also affect the bones that make up the orbit and the eyelids. Drs. Linberg and Sivak have extensive experience in repair after this type of trauma.

A common complaint of many patients is tearing. This can occur for many reasons, including a blocked tear drainage system. This affects children and adults. Dr Linberg wrote the first descriptions of the anatomy of the tear drainage system, and both Drs. Linberg and Sivak specialize in treatment of nasal lacrimal duct obstruction. New methods, including endoscopic surgery are done at WVU.

There are many disorders of facial movement, including benign essential blepharospoasm and hemi-facial spasm. These can sometimes be treated with BOTOX. BOTOX, is purified botulinum toxin which when injected locally, prevents a muscle from comtrating. Ophthalmologist have been using BOTOX for many years in the treatment of these disorders. BOTOX can also be used for cosmetic purposes.

Drs. Sivak and Linberg write papers and present at local, national, and international meetings. They are involved in training future specialists, including one fellow every two years.

Pediatric Ophthalmology and Strabismus

The Pediatric ophthalmologists at the WVU Eye Institute medically and surgically manage eye conditions that usually occur during the first two decades of life. The most commonly treated conditions include crossed eyes (strabismus) or lazy eye (amblyopia), glaucoma, and inherited eye disease. We also treat problems that result from injury to the eye and eye conditions that may occur as a result of medical problems. Routine eye care for children is also available.

Dr. Schwartz and Dr. Bradford use special techniques to evaluate children's vision. Lights, pictures, toys, and letters of the alphabet are used to determine how well a child's eyes are functioning. In general, children should receive an eye exam by age three-earlier if special problems exist.

Both Drs. Schwartz and Bradford completed Pediatric Ophthalmology Fellowships and accepting new patients. Referrals are only necessary if your insurance coverage requires one.

Why worry about a child's eyes?

Babies are able to see as soon as they are born. For the visual system to continue to develop properly, children need clear input from both eyes to the brain. If there is some problem which interferes with vision in either eye or both, the connections from the eye to the brain can become weak or not develop properly. Crossed or turned eyes or imbalance in the way each eye focuses can interfere with this normal development of the visual system.

What questions are asked at the exam?

A child's eye examination begins by discussing any problems the parent recognize. It is important to find out if there were problems with the pregnancy or with the child's birth, and if the child's growth and development are proceeding normally. A history of eye problems in the family is important. The ophthalmologist needs to know about the child's health in general. Are there other medical problems? Has the child had any treatment with medications or surgical procedures? Does the child have any allergies?

If your child has been treated with medications, glasses or contact lenses, these should be brought to the eye examination. The names and addresses of other physicians who may be treating the child should be supplied so that they may be informed of the findings.

How do ophthalmologists examine a baby's eyes?

Many parents are quite surprised to find that a complete eye exam can be performed on a child. A skilled ophthalmologist can get a good idea of how well a child can see based on the way a child uses his eyes to look at and follow attractive toys and lights.

No matter how the vision is tested, it is important to check each eye separately. Two to five percent of children have one eye which does not see as well as the other--a condition called amblyopia or "lazy eye."

For older children who can talk but who do not yet know their numbers or the alphabet, special charts are used which have pictures common in a child's world such as birds, birthday cakes, and stars. Some tests may require the child to point to a letter which matches a letter on a chart. All of these tests show a child smaller and smaller items in order to get an idea of the child's best visual acuity.

Testing for binocular vision (the ability to use both eyes together) and depth perception can also be done early in childhood.

In some special situations, the measurements may be made of a young child's vision based on brain wave measurements while the child watches striped patterns or by observing the way the child looks at black and white stripes on flash cards.

Lights, lights, and more lights.
Lights are used to examine the pupils to see if the eyes are working properly. During this portion of the examination the areas around the eyes such as the eyelids and the tear canals are also examined.

The tiny flashlight can also be sued to see if a child's eyes are straight or turned. If a child is looking straight at the flashlight, the reflection off the front of the child's eyes allows the ophthalmologist to tell whether the eyes are turned or straight. This is important in infants because their wide noses may make their straight eyes look crossed. Sometimes, the ophthalmologist will cover one eye and then the other. If the eyes are not aligned properly, they will jump back and forth when looking at the light or a toy. Wedge-shaped pieces of clear plastic called prisms can be used to measure the amount of misalignment of the eyes.

Why are eye drops needed?

One of the less enjoyable but most essential portions of an eye exam is the dilation of the pupil. This not only allows the ophthalmologist to view the inside of the eye, but the dilating drops temporarily relax the child's focusing power so that nearsightedness, farsightedness or astigmatism (refractive errors) can be accurately measured. Most doctors have preferences for which dilating drops they use. Some drops are given once, some are given more than once, and all take about 30 to 60 minutes to be fully effective. IT may be necessary to have special drops or ointment put in at home and to return to complete the examination at a later date.

What happens after the drops?

Whether your child is attentive or not at his point, or even if he or she is asleep, it can be determined if your child's vision is not in focus by using small lenses and a special flashlight (called a retinoscope). The ophthalmologist can shine a beam of light into the eye and, by holding lenses in the path of this reflection, detect nearsightedness, farsightedness, or astigmatism. It is a somewhat different technique from the one used to fit glasses for adults, but it is, nonetheless, very accurate. From this part of the examination, it can be determined whether your child needs glasses.

How is the inside of the eye checked?

Once your child's pupils are dilated, your ophthalmologist can get a very good look at the structures inside the eye to make sure it is healthy. The inside of the eye is where the retina is located, which is like film in a camera, processing the visual information into signals, which are sent down the optic nerve to the brain. The optic nerve itself, as well as the blood vessels which supply the retina, can be seen in the back of the eye. Special instruments allow the ophthalmologist to see inside the eye in great detail.

What are common visual problems in childhood?

Four percent of children have ocular problems that can diminish vision on one or both eyes. The three most common types of problems that occur are strabismus (misaligned eyes), amblyopia (lazy eye), and refractive errors (focusing problems).

What is strabismus?

Strabismus is a general term referring to eyes which are pointed in different directions. After four months of age, all infants should have straight eyes. One eye may drift in or out, up or down. A crossed eye is known as esotropia. Exotropia refers to eyes that are turned out. Strabismus may be present all of the time or intermittently. Children with strabismus are usually unaware of the problem. Strabismus interferes with the development of coordinated use of both eyes together.

What is amblyopia?

Amblyopia, which is sometimes called "lazy eye," refers to the development of poor vision in one or both eyes. It occurs in infancy and early childhood during the sensitive period of visual development. The earlier amblyopia is detected, the easier it is to treat. When, during late childhood, this early period of visual development passes, visual loss due to amblyopia is no longer a substantial threat.

When should I have my child's eyes checked?

Most physicians examine many parts of the eye during children's medical examinations. However, they will refer children to someone who is a specialist in ophthalmology if they encounter any sign of amblyopia, difficulty in measuring vision, or if they suspect an abnormality of the alignment or structure of the eyes. It is recommended that all children have their vision checked by a pediatrician, family physician, or ophthalmologist by age three, or sooner (age six months to a year) if there is a family history of vision problems. Fortunately, ophthalmologists can perform a complete eye exam on children of any age.

Dr's. Schwartz and Bradford are pediatric ophthalmologists specially trained to diagnose and treat eye diseases in children. We hope you and your child will have a pleasant and informative visit with us.