Comprehensive Eye Care

Diabetic Eye Disease

Diabetes is a disease in which our normal mechanisms for maintaining blood sugar levels become inefficient and our blood sugar climbs to unhealthy levels. High blood sugar levels cause damage to cells surrounding small blood vessels. These cells are like the gatekeepers in our tissues that limit the amount of blood that can enter or exit. When they are damaged, our small blood vessels become leaky and the surrounding tissues are damaged. This process is most damaging in areas of our bodies that have a lot of tiny blood vessels like our eyes, kidneys, liver, hands and feet. If you have been diagnosed with diabetes, it is recommended you have a dilated eye exam every year to monitor for diabetic retinopathy. Diabetic retinopathy is leaky blood vessels in the eye related to damage from diabetes. While the primary goal of the eye exam is to protect your vision, it also helps to monitor the status of you diabetes throughout your body. The eye is the only part of your body that we can view functioning blood vessels without disturbing them. Having your annual dilated eye exam is a vital part of your treatment program to manage your diabetes.

Click here for more information on diabetic eye disease
Click here for more information on diabetes
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Macular Degeneration

Macular degeneration is an aging process that takes place in the area of the retina responsible for detailed, central vision. The process begins when waste products of retinal photoreceptor metabolism begin to build up under the retinal pigment epithelium that lies just beneath your photoreceptors. These waste products are called drusen and are associated with the dry form of macular degeneration.​​​​​​​

There are two types of macular degeneration, dry and wet. The large majority of patients that develop macular degeneration will develop dry macular degeneration. Vision loss related to dry macular degeneration can be significant but often is relatively mild. Treatment for dry macular degeneration includes: nutritional supplements to help improve the protective pigments in the retina, lifestyle changes to reduce your risk of conversion to the wet form, and careful monitoring for conversion to the wet form of macular degeneration.

Wet macular degeneration is less common but can be much more visually devastating. In wet macular degeneration, a network of inefficient and weak blood vessels develop underneath the photoreceptors and begin to leak. This is called neovascularization. The leakage causes the photoreceptors to die and causes damage your vision. Treatment for wet macular degeneration typically involves an injection of a medication into the back portion of the eye to cause the leaky blood vessels to recede. The injections may need to be repeated multiple times over the course of several months to completely resolve the leakage.

At Volusia Eye, we are able to diagnose and monitor patients with macular degeneration through careful examination and advanced retinal photography and ultrasound. Should you convert from the dry form to the wet form, we have partnered with Central Florida Retina & The Macular Degeneration Center to provide treatment in our home office in New Smyrna Beach.

Click here for more information on macular degenration
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Dry Eye Syndrome

Dry eyes tend to develop later in life, or following eye surgery that causes insult to the corneal nerves. Dry eye can be caused by a number of factors. Typically it is a combination of these factors that leads to noticeable symptoms. The tears that protect the surface of the eye are produced by a small gland located at the upper, outer portion of your eye socket, called the lacrimal gland. This gland relies on signals from small nerves in your cornea to produce a steady rate of tears. As we age, or following cataract and/or laser refractive surgery, these signals can become interrupted and the tear production from the lacrimal gland may become insufficient leading to dry eye symptoms.

The tear film of the eye is comprised of three layers. The innermost layer is the mucous layer. The mucous layer acts as an anchoring point for the salty tears produced by the lacrimal gland. The lacrimal gland make up the middle layer, called the aqueous layer. The outermost layer is the lipid layer, produced by oil glands on the edge of the eyelid, called meibomian glands. The lipid layer is designed to prevent the tears from evaporating in dry environments. As we age, the surface of our eye becomes less smooth. This reduction in smoothness reduces the effectivity of the conjunctival goblet cells. This also creates areas where tissue is raised, making it more difficult for the tear layer to keep those areas protected at all times. This translates to poor anchoring of the tear film. The same is true for the oil glands on our eyelids. A slow deterioration of the oil glands and a reduction in their effectivity results in a thin, or poor, oil layer on the eye and increased evaporation of our natural tears.

Sometimes dry eye symptoms are caused by a buildup of inflammatory signaling molecules on the tear surface. The mechanisms behind this inflammatory dry eye are difficult to pinpoint. At Volusia eye, we offer special dry eye testing to aide in determining the cause of dryness.

The tests we offer include tests that determine inflammatory marker testing, your lacrimal gland function, and tear composition. Ocular allergies can cause symptoms very similar to inflammatory dry eye. Volusia Eye Associates offers eye specific allergy testing in office. This test is a scratch test that does not involve any needles. The test takes roughly 30 minutes and the results are determined the same day. We test for allergens specific to the eye. In many cases the testing is covered by your insurance.

What are Cataracts?

Inside of our eyes, we have a natural crystalline lens. This lens bends, or refracts, light rays that come into the eye to help us see. The lens should be clear, but with cataracts this lens slowly becomes cloudy and less flexible over the course of years. Cataracts are the leading cause of vision loss among aging adults.

Cataract Symptoms:

• Blurred vision

• Night blindness and difficulty driving at night

• Increased sensitivity to sunlight and glare

• Loss of seeing vivid colors

Click here for more information about Cataracts

​​​​​​​Cataract surgery is a procedure where the natural, cloudy lens is removed and a new implant (IOL) is positioned in place of the clouded lens. Standard cataract surgery will improve your vision and can correct nearsightedness or farsightedness. Specialty lens implants are available to correct for astigmatic refractive error, as well as presbyopia (inability to see things up close).

Dropless Cataract Surgery

Volusia Eye Associates is now offering DROPLESS cataract surgery

In traditional cataract surgery, the patient is required to instill multiple eye drops onto the surface of the eye for several weeks after surgery. With new technology, we are now able to administer these medications inside the eye during surgery. This allows less irritation to the surface of the eye, improves the convenience of the procedure, while also lowering costs to the patient. Ask about our dropless cataract surgery at your next appointment

Laser Assisted Cataract Surgery

Volusia Eye Associates also offers Femtosecond Laser-Assisted Cataract Surgery to patients either have astigmatic refractive error or have chosen a specialty IOL to correct their or presbyopia.

In laser-assisted cataract surgery, a unique imaging device is utilized to map the surface of the and analyze the lens. This information is used to program the laser to make very precise. Dr. Routh uses the laser to make the incisions in the cornea and the lens capsule that performed manually in traditional cataract surgery. The procedure then continues in the fashion as traditional cataract surgery

Click here for more information about Laser Assited Cataract Surgery

Specialty Intraocular Lenses

**This next section should include the videos that explain the specialty IOL’s. This is where we can add the sight selector link videos as well**

Volusia Eye Associates offers a full line of specialty IOL’s to help reduce or eliminate dependence on glasses following cataract surgery.. These lens options include:

• Toric IOL’s to correct astigmatism

• Multifocal IOL’s to correct presbyopia (poor near vision)

• Toric Multifocal IOL’s that correct both astigmatism and presbyopia
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Click here for more information on intraocular lens implants

What is Glaucoma?

Glaucoma is a disease that damages the optic nerve. The optic nerve is made of more than 1 million nerve cells called neurons. These neurons deliver the signals to the brain that are interpreted as images and give us the gift of sight.
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Glaucoma causes the neurons of the optic nerve to slowly die off. For each neuron that is killed, we lose a small portion of our vision. These subtle changes in your vision are difficult to notice, and a relatively large amount of damage must take place before you are able to tell that you are losing your vision. Glaucoma has been called the sneakthief of vision or silent stealer of sight because of it’s slow and subtle impact on vision. This process is often associated with elevated pressure within the eye, however there are many factors that can contribute to the development of glaucoma

Glaucoma is the second most common cause of irreversible blindness in the United States in patients over 40 years old. Vision lost to glaucoma cannot be restored but further vision loss can be prevented. Many patients diagnosed early and treated properly never develop a perceptible loss of vision.

Currently all treatments for glaucoma aim to lower the pressure of the fluid within the front portion of the eye called the aqueous humor. The aqueous humor is produced inside the eye. The most commonly used treatments are prescription eye drops that decrease fluid production within the eye or increase the flow of fluid out of the eye. In some cases patients may have an inadequate response to the eye drops and require laser treatments and/or surgery to control their glaucoma.

Risk factors for the development of glaucoma include:

• Increasing age

• Family history of Glaucoma

• African, Asian, or Hispanic Ancestry

• Past ocular trauma

• Steroid use

• Conditions that affect blood flow such as diabetes, migraines, and low blood pressure
  
  

Since glaucoma is most often asymptomatic, the American Academy of Ophthalmology recommends a screening eye exam around age 40 for healthy adults, when the earliest signs of the disease may begin to appear. For healthy adults over 65, the academy recommends complete eye exams every 1 to 2 years.

Proper management of glaucoma requires vigilance on the part of the patient and physician. In addition to monitoring of IOP, several tests are scheduled periodically to detect development or progression of the condition. These tests include photographs of the optic nerve to compare year to year, Automated Visual Field Testing to subjectively monitor the impact the condition is having on your vision, and Ocular Coherence Tomography (OCT) scans of the retina and optic nerve to measure the nerve fibers that are affected by glaucoma. With this information, your doctor can make the best choice on how to manage your glaucoma.

​​​​​​​Click here for more information on glaucoma

Selective Laser Trabeculoplasty (SLT)

SLT is a laser procedure that is indicated to treat open angle glaucoma. The procedure can be used as an initial therapy or as additional treatment to reduce independence on IOP lowering drops. Laser energy is applied with a laser that focuses energy to selected tissues. In SLT the laser is focused on to the drainage tissue in the eye called the trabecular meshwork.

The laser energy initiates a chemical and biological change in the tissue that allows for better fluid drainage. This procedure can lower intraocular pressure (IOP) up to 30% when used as initial therapy. These results tend to be less in patients that are currently taking IOP lowering eye drops. Effects of the treatment can last on average 1-5 years, or longer. When the effect wears off, the procedure can be repeated.
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Laser Peripheral Iridotomy (LPI)

An LPI is designed to treat or prevent glaucoma due to angle closure. The anatomical “angle” is the space between the iris and the cornea that leads to the drainage tissue of the eye called the trabecular meshwork.

Risk factors for Narrow Angles

• Shorter eye

• Farsightedness

• Developing Cataract
  
  

Angle closure may also occur as a result of inflammatory conditions, such as uveitis, or vascular conditions, such as diabetes, that can lead to “secondary angle closure” over time. If you are diagnosed with narrow angles you are at risk for developing acute angle closure, a medical eye emergency. An acute angle closure event can lead to a dramatic spike in IOP. This IOP spike can cause the cornea to swell and become cloudy, the eye may become very red, and your vision will be decreased. The increased pressure is also quite painful and can become severe enough to cause nausea and vomiting. An angle closure event left untreated will cause swift, irreversible damage to your optic nerve and cause significant vision loss or even total blindness.

An LPI utilizes a laser to place a small hole in the peripheral edge of the iris to allow for fluid exchange between the front portion and the back portion of the eye. This helps to prevent the pressure from building up in the eye.

iStent inject®

The iStent inject® is the smallest medical device known to be implanted in the human body. It is made of two tiny stents that are designed to restore your eye’s natural ability to drain fluid out of the eye to reduce intraocular pressure. Designed for cataract patients with glaucoma, iStent inject® can be implanted by Dr. Routh at the time of cataract surgery. The device is intended to reduce or eliminate your dependence on eye drops to control glaucoma. You won’t see or feel the iStent inject® stents after they are inserted, but they are designed to effectively manage your eye pressure. Proven to be safe and effective in clinical trials, iStent inject® has been implanted in the eyes of patients around the world, with more patients benefiting from the procedure every day

At Volusia Eye Associates, we pride ourselves on being available to our community when we are needed most. We are often able to see emergency patients on the same day and work closely with our local primary care providers to ensure that emergency eye care is available to all members of the community that may be in need of prompt service. Eye care emergencies include trauma to the eye in the form of a foreign object or blunt injury, chemical burns, red eyes, sudden loss of vision, and eye pain. If you are suffering from any of these symptoms you should immediately seek treatment by an eye care professional.

​​​​​​​Electrocautery refers to the use of a needle or other instrument that is electrically heated and used to carry out a cosmetic or medical procedure. Most people have heard of electrocautery being used in surgeries to help remove unwanted tissue or to seal blood vessels to stop bleeding. However, the technique is also being utilized by eye doctors as it has been found to be beneficial in dealing with a specific eye problem – lashes that grow inwards towards the eye.

Also known as trichiasis, eyelashes that grow at an inward trajectory are a fairly common occurrence and although it isn’t known why some patients experience trichiasis and others don’t, there are some conditions that increase your risk of developing it. This includes chronic blepharitis, trauma to the eye and herpes zoster eye disease.

While eyelashes may seem very soft and like they couldn’t cause any damage, the truth is that when the lashes rub against the surface of the eye, they can actually trigger a number of problems including:

• Infections

• Inflammation of the eyelid

• Scratching of the eye

• Irritation

• Autoimmune conditions

• Trauma

Electrocautery has also been found to be successful in treating a rare disorder called distichiasis, which is characterized by the abnormal growth of lashes from the orifices of the meibomian glands which also causes similar issues to those described above.

How Does Electrocautery Work?

Electrocautery uses a special machine called the PRO-LECTROÒ epilator which works in much the same way as a conventional epilator in that it is designed to permanently remove hair follicles. However, the PRO-LECTROÒ hand-held epilator is designed specifically for the removal of unwanted eyelashes. The adjustable direct current meter delivers the optimal current required to destroy the follicle without causing any damage to the surrounding skin.

It is important to note that some patients require several sessions of electrocautery to achieve the desired results.

What You Can Expect to Happen During an Electrocautery Procedure

Electrocautery is carried out in the comfort of our New Smyrna Beach office and usually takes less than an hour. Once you are seated or laying comfortably, a topical anesthetic may be applied to prevent you from experiencing any discomfort during your procedure. After this has taken effect, your eyelid will be held still by your eye doctor so that the cauterizing can take place. The PRO-LECTROÒ epilator has an ultra-fine needle enabling your problem lashes to be targeted with supreme precision.

Since the wounds used to complete the cauterizing are so small, there is minimal downtime associated with this procedure. You may find that the area feels sore and a little swollen for a day or two, and over the counter pain medications are usually sufficient to alleviate discomfort. Any wound area will heal very quickly, and your eye doctor will give you specific information about caring for your eyes during this time. These should be followed to reduce the risk of complications.

If you have any further questions about electrocauterization, please contact Volusia Eye Associates in Edgewater, FL (386) 230-0300.

Current, Past, Or New Contact Lens Wearer?
Volusia Eye Associates Offers A Full Contact Lens Clinic For Soft And Gas Permeable Lenses To Meet Your Needs.
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**See below for contact lens insertion and removal instructional videos**

​​​​​​​Contact Lens Options

Soft Contact Lenses

We carry a large variety of soft contact lenses in office. These include spherical, toric, multifocal, and daily lenses to fit your contact lens needs. Some of the contact lenses we have in stock are:

• Coopervision: Biofinity family, My Day Daily lens family, Clariti 1 day family

• Alcon: Air Optix family, Dailies Aqua Comfort Plus family, Dailies Total 1 family
• ​​​​​​​Bausch & Lomb: Ultra family, Biotrue dailies family

If your doctor does not see that one of these brands is the best option for you, trial lenses can be ordered and delivered to the office as quick as overnight. There are new technologies available when it comes to contact lenses. For example, Biofinity Energys lenses were designed with digital zone optics for those who use digital devices throughout the day. They are intended to reduce eye fatique and eye strain. Ask your doctor if you are a proper candidate for these lenses if you believe they would benefit you.

Daily contact lenses are becoming more popular as patients are realizing their convenience and comfort. Daily lesnses are disposed at the end of each day. This allows the comfort of a new lens every morning. This also cuts out the need for contact lens solutions. Inserting a fresh contact lens everyday also reduces the likelihood of infection. We carry a large selection of daily lenses to suit each patient, ask to trial one at your next contact lens appointment.

Gas Permeable (Hard) Lenses

Gas permeable lenses are most commonly fit on patient with irregular corneas or patients who suffer from dry eyes. Some of the most common conditions treated with Gas Permeable lenses are:

• Irregular astigmatism

• Keratoconus

• Post corneal transplant surgery

• Dry eye

• Patients who do not achieve desired vision with glasses or soft contact lenses
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If you are interested in learning more, or think you would be a good candidate for Gas Permeable lenses, ask your doctor at your next appointment for more information.
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Soft Contact Lens Insertion & Removal Instructions