Regular eye examinations are the best way to detect glaucoma.  Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see.  During an examination, our doctors will evaluate your intraocularpressure (IOP) by Tonometry.  A high eye pressure reading is often one of the first indicators of glaucoma.   The thickness of the cornea is measured by pachymetry, because corneal thickness affects eye pressure readings.  At the Slit Lamp Microscope, the doctor will inspect the drainage angle during a procedure called Gonioscopy.  An Optic Nerve Exam, performed when the pupils are dilated, is necessary to detect optic nerve damage.

Additional Tests may be ordered that allow unique views and analysis of the state of your optic nerve, comparing the way the optic nerve appears during the test to a database of other individuals categorized by age, gender, race, and level of glaucomatous damage.  A Humphrey Visual Field (HVF) or Frequency Doubling Technology (which detects damage faster and earlier in the disease process) analysis of your current amount of peripheral field loss will be ordered.   The Ocular Coherence Tomographer, (OCT) scans through your dilated pupil to assess the quantity and quality of the optic nerve fibers themselves.  The Heidelberg Retinal Tomographer (HRT) scans the appearance of the optic nerve, including changes in its shape and appearance over time.  In Glaucoma, the elevated eye pressure permanently damages these fibers.  Tracking the amount of nerve fiber loss helps your doctor in the determining when and if to intervene with additional glaucoma treatment.   Digital Optic Nerve Photographs or 3–Dimensional Optic Nerve Photographs will be taken to aid in the further evaluation of your optic nerve’s appearance over time.  Blood flow to the microscopic cells of the optic nerve is an important factor in optic nerve health, and may be assessed through Ocular Blood Flow Analysis and 24-hour Blood Pressure Monitoring (similar to wearing a Holter monitor). 

                      Three scans are taken of the optic disc and nerve fiber layer. These are combined to create a high quality, 3-D topography.

Our research at the Eye Research Foundation set the
standard protocol for how to measure ocular blood flow.

EFEI has the FDT which can detect visual field loss in perimetrically normal eyes with open-angel glaucoma.

Recently, research has indicated that a technology known as FDT is very useful in detecting visual field loss secondary to glaucoma.  Additionally, this same technology has also been shown to predict the visual field loss pattern that would be seen on standard testing. 

Macular Degeneration Diagnosis

Our state-of-the-art Diagnostic Center offers patients the latest in advanced diagnostics for Macular Diseases.  Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see.  You will be given an Amsler Grid to look at in the office and also one to take home to test your vision daily.  This looks like a checkerboard with a black dot in the middle. If the grid seems blurry or wavy, it may mean that you have AMD.  Drops are put in your eye that help to widen (dilate) the pupils. Then, using a special magnifying lens, your eye doctor will look at your retina. 

Normal OCT Scan	OCT Scan Showing Wet AMD

Specialized imaging tests may be ordered to better assess the health of the macula.  

• We have the newest CIRRUS HD-Ocular Coherence Tomographer, (OCT) scans through your dilated pupil to assess the quality of the macula and surrounding retinal tissue, reflecting damaged areas and in the case of Wet Macular Degeneration – fluid. 
• In Fluorescein angiography (FA),  a special dye is injected into your arm and as the dye passes through the blood vessels in your retina, pictures are taken of the back of your eye, allowingyour eye doctor to see the blood vessels of the retina, which is critical to assessing your AMD. Since wet AMD is caused by abnormal blood vessels that grow under the center of your retina, this test is often very helpful.  
• Indocyanine Green (ICG) Angiography, a procedure similar to Fluorescein angiography,  uses Indocyanine green dye which can show more detail than Fluorescein angiography. 

Diabetic Retinopathy Diagnosis

Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see.  A detailed history of your blood sugar variations will be obtained.  Drops are put in your eye that help to widen (dilate) the pupils. Then, using a special magnifying lens, your eye doctor will look at your retina.  Specialized imaging tests may be ordered to better assess the health of the retina.  The Ocular Coherence Tomographer, (OCT) scans through your dilated pupil to assess the quality of the retinal tissue, reflecting areas damaged by diabetes.  In Fluorescein Angiography (FA), a special dye is injected into a vein in your arm and as the dye passes through the blood vessels in your retina, pictures are taken of the back of your eye. This test allows an eye doctor to see the circulation of the retina, which is critical to assessing the level of damage to the retina from diabetes.

 

Dry Eye Disease Diagnosis

Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see.  A detailed history of your eye comfort will be obtained.  During an examination at the Slit Lamp Microscope, our doctors will evaluate your ocular surface and surrounding tissues.

Dry Eye Disease Diagnosis   Successful treatment of dry eye disease is dependant on correctly diagnosing the underlying cause and level of severity of the disease.  At EFEI, we take a comprehensive approach to treating this debilitating disease.  We not only look at the amount of tears produced, but at the overall health of tears and the way they lubricate the eye.   Schirmer test -- A filter-paper strip is placed under the lower eyelid to measure the amount of tears that are produced in a given time frame.  Lissamine green and Fluorescein dyes -- These special dyes are used to show dry areas of they eye and identify underlying inflammation.  They also help to access tear film quality and stability.   Lid Evaluation -- Lid disease is a major contributor to unhealthy tears.  If lid disease is present, it must be managed first in order to successfully treat dry eye symptoms.  Examples of lid disease are:  Blepharitis, Meibomitis, and Lagophthalmos (incomplete lid closure).

Cataract Diagnosis

Your Visual Acuity will be assessed using the Snellen eye chart which measures how well each eye can see.  A detailed history of the quality of your vision will be obtained, including if you are bothered by glare or if you have been experiencing problems seeing in dim light.  A refraction will be performed to determine you best level of vision and if your vision can be improved by changing your glasses (instead of surgery).   Drops are put in your eye that help to widen (dilate) the pupils. Then, using a special magnifying lens, your eye doctor will look at your natural lens (which over time becomes yellowed and cloudy – a cataract).  Your overall eye health will be assessed as well.

Once it has been determined that you are a good candidate for Cataract Surgery,
your questions will be answered and your surgery may be scheduled.