At the time that I diagnose cataracts in the clinic, many people ask, "What is a cataract? Is it a film over my eyes?".
Well, not really. The front clear window on the eye is the cornea. Under the cornea is the colored part of the eye called the iris. Behind the iris is the lens which is normally clear. By the age of 40, most people have at least the beginning of a clouding and yellowing of the lens which we call a cataract.
You've heard the phrase a picture is worth a thousand words.......
Cataract Prior to Cataract SurgeryIntraocular Lens After Cataract Surgery
We normally remove cataracts with phacoemulsification which is very high frequency ultrasound that breaks up the cataract into pieces and simultaneously vacuums it out. Typical cataract removal with the placement of an artifical lens is shown in this high speed video:
Here is a video that shows a patient having their scarred cornea removed (for a corneal transplant) followed by the cataract being removed. It allows you to get a real sense of the size and color of a cataract:
Dr. Lanier recently retired from over 30 years of serving patients in the Houston area. I can remember seeing his patients who had corneal transplants that he performed in 1971…the year I was born! He always put his patients first. He proved himself as an expert in the treatment of corneal and external infectious disease and corneal surgery through his many contributions to the field of ophthalmology. Dr. Lanier worked shoulder to shoulder with the greatest minds in eye care. We, at Houston Eye Associates, appreciate his leadership as the President of HEA, a position that he held for many years with poise and vision. He and his wife Margaret were the proud honorees of the 2016 Houston Eye Associates Foundation Eye Ball (one of many, many recognitions over the years).
As the legend goes...
He once hit a hole in one because he was running late.
When the ball drops in Times Square, he catches it.
His mind is so sharp, he uses it to make his cataract incisions.
When asked why he doesn't do refractive surgery, he responds "kiss my ASCRS".
The round corneal transplant was his idea.
Dean Martin was once caught lipsynching his song.
He types 80 words per minute, which each hand.
He was the first one to suspect baseball players of using steroids.
Although his mind is clean, his martinis are very dirty.
As of 2016, he has plans to play in the sun and enjoy his family…a well deserved retirement!
All of the HEA physicians will be helping to continue the care for his patients. I will be in Dr. Lanier’s treatment area “POD7” now Suite 270 and am excited to see some of those patients that I helped Dr. Lanier care for when I was in fellowship with him in 2001-2002. You can rest assured that he has made me promise to care for his patients with the same excellence in medicine and customer service that he provided!
Ocular Surface Disease: Infection! Oil! Inflammation! Dryness! These are easily the most common eye problems that I see and treat.
Significance and effects
Numerous patients come to see me for dry, irritated, burning, crusting, sticky, red, swollen eyes and eyelids (what we call ocular surface disease). Why? Understanding ocular surface disease is half of the battle and is the reason for this very long explanation. This is what I want my patients to understand about these frustrating problems.
Across cultures, humans typically have developed varying habits of hygiene. We shower or bathe, we wash and comb our hair, we brush our teeth, etc. We do this as a way of maintaining our bodies, keeping ourselves healthy, and being pleasing to others around us. Generally speaking the main weapons we use in the fight for hygiene are simple: water and soap. The idea is that soap loosens dirt and bacteria and the water washes them away. Simple.
However, when it comes to the eyes, soap stings (because of the alkaline pH) and many people don’t even light getting water in their eyes! Satisfying the hygiene goal thus becomes more complex and leads to problems with infection, oil, inflammation, and dryness.
The eye care community wants to improve the basic ocular health of millions of people suffering with dry, irritated, burning, crusting, sticky, red, swollen eyes and eyelids, and have stepped up efforts to teach patients to be as mindful of cleaning their lids and lashes as they are of bathing and brushing their teeth.
The three main factors in ocular surface disease are infection, oil, and inflammation. Dryness is a somewhat separate but related factor that also often needs to be addressed.
Imagine going to your dentists office. One thing you can count on at the end of your visit is that your dentist will emphsize the importance of daily brushing and flossing. If we skip brushing and flossing, we end up with cavities (dental infections). Basic. Likewise, we all know that our breath starts kickin’ like Bruce Lee when we don’t brush. That’s because of the build up of bacteria. Our mouths have a mucous membrane lining. Where we have mucous membranes, we also have bacteria. We all have bacteria in our mouths yet we don’t rinse our mouths out with antibiotics every day to decrease bacteria; we just brush. Similarly, the ocular surface is a mucous membrane and has a similar tendency to accumulate bacteria because of the moisture present.
In addition to bacteria, the follicles of the eyelashes commonly are a home for a skin mite called Demodex.
One hundred percent of us have bacteria on our lids and lid margins and it has be found that most of us also have Demodex! These organisms can lead to oil gland problems and inflammation (redness). However, we each have a slightly different reaction to these microbes. How do we routinely keep these critters at bay?….lid scrubs.
Now imagine going to your dermatologists office for acne. We all know that bacteria, oil, and inflammation are part of acne yet we don’t think of acne as an infection of the face. We also don’t expect acne to completely resolve in a day or a week (even though we all want it to). It takes significant effort and daily attention over long periods of time to improve the quality of the oils and the functioning of the oil glands to decrease acne. The same is true for the oil glands of the eyelid margins. These glands are called meibomian glands. The oils they secrete should be the consistency of olive oil. These oils serve to coat the surface of the eye, prevent the rapid break up of the tear film, and reduce the evaporation of tears. When influenced by bacteria and inflammation, the meibomian gland oils become thick like butter and can be squeezed from the lids like toothpaste.
The thickness of the oils can clog the gland leading to the formation of a chalazion (stye). We called this meibomitis or meibomian gland dysfunction. This process is cumulative and as it occurs, more and more glands become involved making the lids thicker and redder. This process can even cause permanent scarring and destruction of the meibomian glands. As you can see, although chalazia involve bacteria, they are not actual infections. Instead, they are much more like really big pimples and as such can lead to severe “acne” of the eyelid margins. Meibomian gland dysfunction encourages bacterial growth and inflammation. The interaction between bacteria and eyelid oils can actually lead to the chemical formation of soap bubbles in the tear film which stings irritates just like regular soap does.
The strategies for handling meibomitis involve thinning the oils with heat, expressing them from the lids, and reducing inflammation.
Inflammation (redness and swelling)
People that have experience with asthma or eczema have an intimate understanding of the recurring nature of inflammation. In these conditions, the immune system which normally acts as a defense mechanism for protecting us from infections and cancers gets “confused” and becomes overactive causing damage to our body's normal tissues. Overactive inflammation of the eyelids and conjunctiva (the white of the eye) causes the collateral damage of redness, swelling, and itching. It can even cause the growth of blood vessels into the cornea leading to scarring and blurred vision. This inflammation in ocular surface disease comes and goes depending on the severity of the problems with infection, oil accumulation, and dryness.
Therefore, it’s important to remember that red eyes or red lids do not necessarily mean that an infection is present, but rather that inflammation (from many possibly causes) is present. The pathway of inflammation can be interrupted with many strategies, the most common of which is steroids.
Most ocular surface dryness is due to one or all of the factors above. It is for this reason that I feel that most patient’s symptoms of ocular dryness is not actually due to truely dry eyes (meaning not enough tears) but rather dry eye sensation (the feeling of not having enough tears). In most cases, treating infectious problems, oil gland problems, and inflammatory problems leads to substantial improvement in the dryness symptoms. It is not uncommon for some people to either not blink completely during the day or sleep with their eyes partially open. These are considered evaporative dry eye problems because they cause the tears (which are adequate in quantity) to either not spread across the eye properly or evaporate from the eye too quickly. True aqueous tear deficiency (not having enough liquid tears) is much more rare.
Common ocular surface disease states
Various combinations of the ocular surface disease factors described above make up the common states of ocular surface disease outlined below. The main causitive factors of each condition is written in parentheses. Notice the high degree of overlapping symptoms between these conditions. This causes them to be easily confused for one another and leads to a high degree of overlap in the treatments. Keep in mind that many of these conditions are chronic and are therefore managed with treatment rather than cured.
bacterial blepharitis and conjunctivitis (infection): bacterial infection of the eyelid margins and the white of the eyes; commonly caused by Staphlyococcus, Streptococcus, Haemophylus; symptoms include: redness, swelling, itching, tearing, burning, crusting
viral conjunctivitis (infection): often referred to as “pink eye” and caused by Adenovirus that can cause corneal spot scars (keratitis); symptoms include: severe redness, swelling, itching, tearing, burning, blurred vision
Staphylococcal hypersensitivity (infection and inflammation): hyperactive immune response to the exotoxins of Staphylococcal bacteria on the lid margins and lashes leading to scarring of the cornea; symptoms include: recurring redness, swelling, pain, blurred vision
Demodex blepharitis (infection and inflammation): infection of eyelash follicles by the Demodex mite; symptoms include: redness, dryness, crusting, itching
meibomitis (oil and inflammation): inflammation of the meibomian glands with thickening of the eyelid oils: symptoms include: redness, dryness, blurred vision, fluctuating vision, recurring chalazia (styes), pain, swelling
ocular rosacea (infection and oil and inflammation): inflammatory response to Demodex, bacteria and oils affecting the lids, the white of the eyes, cheeks, nose and forehead with dilated vessels, sometimes also with thickening of the skin of the nose (rhinophyma); symptoms include: redness, flushing, dryness, burning, pain, blurred vision, fluctuating vision
allergic conjunctivits (inflammation): immune response leading to inflammation of the eyelids and the white of the eyes; commonly caused by environmental allergens and medications; symptoms include: itching, redness, tearing, dryness
dry eye syndrome (infection and oil and inflammation and true dryness): either the sensation of dryness or actual dryness of the ocular surface; symptoms include: dryness, burning, pain, blurred vision, fluctuating vision
The basic regimen of treatment for all of these conditions is the cleaning of the eyelid margins at least once per day, and in active disease, twice per day. There are many effective strageties for cleaning the eyelid margins including various cleansing formulations and baby shampoo. I discourage the use of baby shampoo and instead shout that the best long term daily cleaning regimen is with Cetaphil Gentle Skin Cleanser For All Skin Types which I describe here: Lid Scrubs
In addition to this basic cleansing regimen, the treatments of ocular surface disease are tailored based on the major underlying factors that are causing the problems.
Customized treatments for the various states of ocular surface disease are categorized below according to the factors they address. This is an extensive (but not exhaustive) list of the most common treatments available.
Cataract surgery is normally performed with ultrasound (phacoemulsification) and more recently has been aided by the use of a femtosecond laser in some cases. When you decide you are ready for cataract surgery, you will have options to consider. Just as in trying to answer the question “What is the best car?”, the answer to “What is the best intraocular lens for cataract surgery?”, is highly variable depending on the person and circumstance. Below, I have listed the major considerations with my typical recommendations highlighted and you can see videos on these lens options and laser cataract surgery here: Laser Cataract Surgery & Lens Options
The natural lens that we are born with has the ability to change shape very quickly when looking at distance, intermediate, and near objects. As we gain experience (get older), the lens gets stiffer and loses some of its ability to change shape. This is called presbyopia and leads to the need for reading glasses or bifocals. When cataract surgery is performed we have to consider this issue with the new, artificial intraocular lens (IOL).
Monofocal lenses: With a monofocal lens, we decide on one focal distance that is fixed. The options are: distance (10 feet and beyond), intermediate (computer distance), or near (reading distance). The benefit of monofocal lenses lies in the sharpness of vision that they provide and high predictability with minimal or no issues with glare, halos, or fuzzy outlines. However, you can expect to still need glasses at least for near and intermediate tasks.
Multifocal lenses: Multifocal lenses use concentric rings of light bending power to simultaneously provide vision for two of the three focal distances above. The benefit is that there is less dependence on reading glasses for near or intermediate objects. The drawback is that it is more likely that you may experience glare, halos, and fuzzy outlines (particularly at night) due to the superimposed rings of power.
Accommodating lenses: This lens tries to most closely mimic the actual function of the natural lens. These lenses change shape to allow for focus at more than one distance. They tend to give sharper vision than multifocal lenses but sometimes don’t perform for multiple distances as well as advertised. Sometimes, these lenses move into distorted positions causing blurred vision that may require further surgery.
Monovision: Monovision is intentionally setting the focus of one eye (the dominant eye) for distance while setting the focus of the other eye for intermediate or distance. This can be a very successful strategy for patients that are used to doing this in contact lenses. Not everyone who tries monovision ends up liking it, so it is best to have a trial of monovision prior to choosing this option.
Corneal astigmatism correction
Corneal astigmatism is an uneven curvature of the cornea that blurs vision. Some astigmatism can also be caused by the lens, but since the lens is being removed in cataract surgery, it is not of significance.
Toric lenses: Toric lenses can be used to reduce or fully neutralize corneal astigmatism and allow for better vision without glasses.
Laser correction of corneal astigmatism: This involves one of the many variations of laser refractive surgery such as limbal relaxing incisions (LRIs), LASIK, or PRK.
Most intraocular lenses are made of either acrylic or silicone.
Acrylic lenses: This is the most common intraocular lens material.
Silicone lenses: This material is less common due to its interaction with silicone oil that is sometimes necessary for patients with retinal detachments.
Extra measurements during cataract surgery
Intraoperative wavefront measurement using the ORA system allows for a verification of the intraocular lens power and position at the time of surgery. It can be particularly useful for patients undergoing cataract surgery that have previously had refractive surgery. It is sometimes used for verification of the proper placement of toric lenses.
Keep in mind that despite all of these choices and interventions, it is not uncommon for patients to still be able to sharpen their vision further after cataract surgery with glasses and/or contact lenses even if they choose to go without them. Additionally, several of these choices (multifocal lenses, accommodating lenses, topic lenses, laser correction, and intraoperative wavefront measurement) involve extra costs beyond what Medicare or your private insurance will pay.
I look forward to discussing cataract surgery options that are specific to you.
One of the lessons I learned early on in the treatment of corneal disease was the lesson of patience. Most corneal transplant surgeries require many months before the full benefits can be appreciated. Depending on the type of corneal transplant, I usually explain to my patients that it takes three to six months before we know what the best vision will be after surgery. In cases that are very complex or cases that involve multiple surgeries, that time can be even longer, sometimes taking a year or more.
For inspiration, I'd like to share the experience of one of my patients who after having several surgeries with me over a time span of several years, went from two corneas that looked like this:
to two corneas that now look like this:
After being legally blind for approximately one year, she now sees well enough to have drawn me the art below as a token of her appreciation and as inspiration for my other patients with complex corneal condtions. Thanks!!!
This is a very nice note that I recently recieved from a greatful patient:
I'm happy I could help!
Sometimes corneal surgery can be performed to help a patient with their outward apperance. It can make a difference in confidence and allow some people to be more comortable around cameras and in front of groups. Re-evaluating a longstanding corneal condition can occasionally reveal that we now have solutions to problems to used to be much more difficult to solve.
I'm eager to help with your corneal condition as well. Please give my office a call to set up an appointment at 713-558-8709.
Corneal specialists are physicians who have completed at least four years of college, four years of medical school, one year on intership, three years of ophthalmology residency, and one year of specialty corneal training called fellowship. They are skilled in the techniques of surgery of the front part of the eye. Some of the most common conditions that corneal specialists treat are cataracts, keratoconus, Fuchs’ dystrophy, external eye infections, and corneal scars. If you live in the Houston area you’re lucky because there are many well qualified corneal specialists. The factors that may lead to you choose one can vary depending on what is most important to you.
In providing care to patients I feel it’s important:
to put you first
to help you understand your eyes and your options
to provide top quality care in a setting of trust, compassion, and experience
The first question most patients have when faced with the idea of eye surgery is, "Will it hurt?!"
The simple answer is that in most cases there is very little if any pain asociated with eye surgery. Remember, we want you to be comfortable!
There are three main types of anesthesia for eye surgery:
1) Topical anesthesia: This is most commonly used for cataract surgery and some other surgeries of the ocular surface. In topical anesthesia drops are placed in the eye and the surface becomes numb within minutes. When this is used for cataract surgery, often a numbing medicaiton is also injected into the eye at the time of surgery to further aid in comfort. Topcial anesthesia does not numb the vision or the movement of the eye and the blink reflex continues to function. Movement of the eye during surgery is controlled by the patient with help from the surgeon. The bllink reflex is controlled with a speculum that holds the eyelids open without pain. Most surgeries using topical anesthesia are short, lasting 10 to 30 minutes.
2) Retrobulbar anesthesia: This is most commonly used for corneal transplant surgery and other types of intraocular surgery that take longer to perform than cataract surgery. An anesthesiologist puts the patient to sleep for approximately 5 minutes using intravenous medications. During that time an injection is performed behind the eye that numbs the sensations, numbs the vision, numbs the eye muscles, and numbs the blink reflex. The eye is usually numb for threee or more hours and during this time there is no pain, no vision, and no movement of the eye or eyelids. As the numbing injection wears off, sometimes temporary double vision can be experienced.
3) General anesthesia: This type of anesthesia is reserved for larger and longer types of eye surgeries. In general ansthesia, the patient is put completely to sleep by the anesthesiologist. It is also used in pediatric cases and other situations in which the patient may not be able to voluntarily keep still.
In the time after eye surgery, your eye may feel somewhat scratchy and slightly sore. This is normal, and if necessary can be managed with over the counter oral pain medications. As the post-operative drops are used and time passes, the eye will feel more and more normal.
The type of anesthesia that is right for you will be discussed as we are planning surgery. As stated above, we want you to be comfortable throughout this process!
There are three basic types of corneal transplants:
1) Replacement of the front part of the cornea: anterior lamellar keratoplasty (ALK), below:
2) Replacement of the back part of the cornea: endothelial keratoplasty (DSAEK, DMEK), below:
3) Replacement of the full thickness of the cornea: penetrating keratoplasty (PKP), below:
Which type of these transplants is right for you depends on several factors. If the problem is localized to either the front of the cornea or the back of the cornea, then only that portion of the cornea needs to be transplanted. If the problem involves all of the layers of the cornea, or if the partial corneal transplants will not be sufficient to solve the problem, then a full thickness corneal transplant is necessary.
Penetrating keratoplasties (PKPs) are performed for previous PKPs that have failed, DMEKs or DSAEKs that have failed repeatedly, full thickness corneal scars from infections or trauma and other situations in which the surgery may be very complex and involves multiple layers of the cornea.
If you have questions, I am happy to help determine which type of corneal transplant may be necessary for your particular situation.
“Our family is very grateful to Dr. Mark Vital for the wonderful care we have received for our eyes since he first opened his practice. I have referred many friends as well as patients from my practice and they all tell me of their appreciation of his calm and unhurried manner and his exceptional capacity to listen carefully to questions and fears.”
“Because he was not completely sure of my diagnosis, he called in the other cornea specialist who agreed with his approach. Dr. Vital carefully explained to me his thinking, and I too agreed this was the way we should proceed.”
“I went home that day, concerned about my eye but feeling that as always at HEA, I was in good hands. I’m a hospital administrator by trade and am familiar with how to research a doctor’s training and actual experience and immediately started that process. From experience, I also know there are doctors, and then there are DOCTORS, and I want only the best! I wasn’t surprised to find that his credentials are impeccable, and just what one would hope for when dealing with a personal situation that is uncomfortable and frightening. He is very well trained, has a spotless record, has passed all the board exams I would expect, and clearly is one of the best I could hope to find.”
“After several visits to Dr. Vital, I am even more pleased and impressed! He is truly wonderful. He is very personable, and obviously knowledgeable. He takes the time to really explain to me what is happening with my eye, and what I can expect for the future. He shows me actual computer drawings or the changes, visit to visit, and this is very comforting. Although his waiting room is always full, I never feel rushed or that he doesn’t have time to make sure I am comfortable with the course of treatment. I love that about him!”
“I am also a licensed social worker, and I know firsthand how important it is for a patient to have confidence in their doctor. As patients, we need to feel like our physician knows what they are doing, that they have our personal best interests in mind, and that they will do what it takes to achieve the best possible results in our specific situation. All of this is true with Dr. Vital, and it really “came home” to me as I was waiting to see him for my most recent appointment.”
“I was in his waiting room and I noticed in looking around that there were many people there, along with their interested family members, who looked to have more difficult and disabling conditions than I was experiencing. I immediately felt guilty for feeling sorry for myself as I could see, my situation could definitely be worse. AS I began talking to some of these people, I learned that many of them had been seeing Dr. Vital for a very long time, and I was amazed at what they said about him. Person after person spoke about him in what I would only call “heroic” terms. They talked about having lifelong conditions and not ever feeling hopeful until they began seeing Dr. Vital. Many of them had seen numerous physicians throughout the years and ALL spoke of Dr. Vital as being absolutely the best. They, like me, felt very appreciative of being able to be one of his patients. They talked about his patience, how much they feel he cares about them as individuals, and how easy it is to talk with him. These are experiences they had not had with other practitioners.
When I went in to see Dr. Vital, I told him about my experience in his waiting room and how much it meant to me. His response to me was very humble, another very positive quality about him. I could tell he was genuinely pleased, and not just because someone was saying nice things about him, but more because he feels good about being able to give his patients the best service he possibly can, and more importantly, that he gives them confidence. In fact, I left that appointment feeling more confident than ever that I am in good hands and that the end result for me will be positive.”
“Rachel, Thank you for being so nice when I called and asked questions. It meant a lot to me. I've had a stressful three years. You've made some of that easier.”
“We recently received positive feedback from a claimant regarding his appointment with you. THANK YOU for your outstanding service to this claimant! We greatly appreciate your continuing service to our veterans and active duty servicepersons and your understanding of their special concerns. Thank you for all of your contributions!”I am writing this testimonial to promote “Dr. Mark Vital and his staff for a great patient experience. I came from the Beaumont-Mid-County area of Texas and recommend him highly as the best ophthalmologist to see at the Houston Eye Associates Facility.
Dr. Vital successfully performed my cataract surgery and to me is an exceptional and experienced doctor in his field. I have a great level of trust in him since he helped me to understand my options to have the best vision possible. He patiently and unhurriedly listened to my story and answered all of my many questions. He assured me that he had done many surgeries on people with my history of eye problems following RK surgery and retina re-attachment with success. His office environment is very pleasant and the staff were courteous when scheduling my appointments since I live an hour from Houston. I never have to wait very long in the reception area to see him and will return as often as necessary in the future. I highly recommend others to make an appointment with him!”
Eyelid hygiene (with lid scrubs) is very important in preventing eyelid infection and maintaining a healthy eyelid margin. Without proper cleaning of the eyelids, lid margin disease can develop. Lid margin disease involves overgrowth of bacteria, thickening and accumulation of oily secretions, accumulation of dead skin cells, and inflammation at the base of the eyelashes. This eyelash debris can lead to the problems of blepharitis, meibomitis, dry eyes, Staphlyococcal hypersensitivity, and ocular infections. Demodex folliculorum is a skin mite that causes one type of blepharitis and is commonly seen in patients that do not adhere to a regimen of eyelid hygiene. We know that most serious intraocular infections following surgery come from the patient’s own eyelashes. So, eyelid hygiene is particularly important before and after eye surgery. Lid scrubs should be performed daily, either at the time of washing your face, or when taking a shower or bath.
How should I perform lid scrubs?
Cleaning the eyelashes and lid margins should be thought of in the same way that we think of brushing our teeth. We don’t think of plaque on our teeth as an infection, yet it does involve bacteria. And in order to reduce the bacteria that cause plaque, we don’t wash our mouths out with antibiotics every day, we brush. Similarly, we should all carefully clean the eyelid margin and eyelashes to reduce bacterial overgrowth. We know that soap can reduce the growth of bacteria. However, both kids and adults are reluctant to get soap in their eyes because it burns. Therefore, I recommend thorough cleaning of the base of the eyelashes and eyelid margins with a non-stinging, gentle cleanser called Cetaphil on a cotton swab. Cetaphil is not a soap. It comes in cleansers and moisturizers. I feel that the best product for cleaning the eyelids is called Cetaphil Gentle Skin Cleanser For All Skin Types.
This cleanser is not actually soap so it does not burn. Other types of Cetaphil may burn, so stick with the one For All Skin Types. It is not dangerous or damaging if it gets into the eyes. It can be used to reduce mattering and debris on the eyelids and around the eyes. Moisten the cotton swab with water. Apply the Cetaphil to the swab and clean the base of the lashes as if you were applying eyeliner or masquera. Then, rinse with water. Even if you feel uncomfortable about using a cotton swab, Cetaphil can applied with the hands and fingers around the eyes and still be very effective. You can wash your whole face or entire body with Cetaphil. Because it is so gentle and hypoallergenic, it can be used once or many times daily without stinging, drying, or cracking the thin delicate skin of the eyelids. I believe in it so much that I myself have been using it every day for years. PLEASE DO NOT USE BABY SHAMPOO! Eye care providers have been advocating the use of baby shampoo on the eyelids for years because better products were not available. But because baby shampoo is a soap, it is not good for the ocular surface. Baby shampoo can still burn the eyes and be somewhat drying to the skin. Other products exist for cleaning eyelids and can also work well, but Cetaphil still remains my favorite.
Answer: This is what you can expect in the process of making your appointment and visiting our office.
Appointments can be made either by someone in my office or by Houston Eye Associates’ main scheduling department. If you speak to the scheduling department, let the scheduler know that you need to set up an appointment with Dr. Vital and specify your preferred date, weekday, or time. Budget at least an hour and possibly longer if you expect that you may need to set up plans for surgery. Keep in mind that I handle many complex eye conditions and sometimes our clinic schedule is thrown behind due to serious and unexpected patient problems or emergencies.
You can access and download patient registration forms from the HEA website (www.houstoneye.com/houston/patient-forms.htm) or go the "My Online Clinic" button in orange at the top of this page, to fill out prior to your visit. Please bring as many of the following items and information with you as possible to allow us to help you better:
1.Your current glasses (even if broken)
2.Your current contact lenses, case (and contact peel pack for disposable lenses), as well as the names of your solutions if you have any
3.The actual eye drops that you are currently using or have recently used
4.The names and dosages of your oral medications
5.The name, phone number, and address of your pharmacy
6.The name, phone number, and address of your referring doctor
7.The name, phone number, and address of your primary care doctor
8.Your insurance cards
You will first be interviewed and examined by one of my ophthalmic assistants (OAs). This person will record some notes regarding the reason and circumstances of your visit. He or she will also perform some or all of the following: a check of your vision, a check of your intraocular pressure, a check of your glasses prescription, a refraction in order to measure your best possible vision, and an instillation of dilation drops.
You will then be moved to another room to see me. I will review the information collected to that point and again discuss with you the circumstances of your visit. After I perform an exam, I will record my findings, and discuss my impressions and recommended plans with you.
The healing process is collaborative: I will not force or manipulate you into treatments. However, you share in the responsibility for your improvement by being compliant with the plan of action we agree upon.
My team is passionate about helping you.
My team is passionate about caring for your eyes.
My team is passionate about preserving and improving your vision.