We perform all ranges of comprehensive general ophthalmology services.
Comprehensive Eye Care
We perform all ranges of comprehensive general ophthalmology services. Refractions (measurements for glasses) are performed using state-of-the-art computerized autorefractometers. Measurements are then personally fine-tuned by Dr. Tinoosh to achieve the most accurate measurement for your eyes.
We see patients of all ages and perform vision exams to test for eye glasses, strabismus and lazy eyes. We also offer soft and Toric (astigmatic) contact lenses. We see patients for corneal, eyelid, retinal and neurological problems related to the eye.
We see eye emergencies promptly when possible.
We manage patients with corneal foreign bodies, eye infections, corneal abrasions, red eyes, eyelid lacerations, and other eye emergencies.
Examinations for eye glasses and contact lenses are done with the most sophisticated equipment available. We have all the latest style frames and designer sunglasses for your convenience.
Our friendly, experienced staff, in conjunction with our top notch equipment, will assist in addressing all your eye needs, and achieving the best results for your eye health.
We perform all ranges of droopiness of the upper eyelids, as well as drooping or sagging skin and prolapsed puffy pouches under your eyes, which can be corrected by a procedure called blepharoplasty. When these conditions are present, patients often complain of reduction of their upper visual field, especially towards the end of the day when they are fatigued. The eyes feel droopy, and patients often have to use their forehead muscles, or raise their brows, in order to lift their upper eyelids. They may also have a tired look to their eyes and face. Our goal is a result that looks natural and provides good function of the eyelids.
Paying for Eyelid Surgery
Droopiness of the upper eyelids, if significant, is considered a medical necessity which may be covered by medical insurance. Diagnostic testing will be required prior to obtaining insurance approval for coverage. A visual field test and photography are required for documentation. Pre-authorization of the procedure with your insurance company is required to clear you for the procedure.
Cosmetic Eye Lid Surgery
If you are considering Blepharoplasty for cosmetic reasons, medical insurance will not be filed as cosmetic procedures are considered elective, and are not covered by medical insurance. Financing options are available through Care Credit. For more information or to determine candidacy, please contact our office to schedule a cosmetic consultation.
Before & After Bleph Surgery Photo’s
Dry Eye Management
The tear film is composed of 3 layers: mucous layer, water later, and oil layer. Any imbalance in the production of any of these layers may result in dry eyes. Dry eyes can be caused by a myriad of reasons, including allergy, medications, auto-immune diseases, Sjogren’s syndrome, or may be simply age related.
Managing dry eyes includes different modalities:
Replacing tears: This can be achieved by artificial tear preparations. There are many preparations available on the market. Each may be advantageous in a different way, depending on the type of tear deficiency.
Slowing down the drainage of natural tears: This can be achieved by punctal plugs. Punctal plugs are tiny and microscopic, and they do as their name suggests – they plug the drainage pores of the eyelids to prevent natural tears from draining faster, thereby lubricating the eyes longer. This can be a very simple and effective method in managing dry eyes.
Medicated drops: These work by reducing the inflammatory component of dry eyes, and may increase the tear film production overtime.
Over-the-counter natural remedies: Fish oil and flax seed oil have been clinically shown to help reduce dry eye symptoms by increasing tear production.
Diabetic Eye Care
Diabetes Mellitus is a systemic disease that affects the small blood vessels of the body. Your primary care doctor may recommend a yearly eye examination. The eye is the only organ in the body where the small blood vessels can be seen directly by examination and without invasive testing. The status of the blood vessels of the eye may indicate the status of the blood vessels to the rest of the body. This information is important in the management of diabetes. The eye may also be affected by diabetes. Diabetes can cause bleeding and swelling of the retina (the receptive layer that lines the back of the eye). Diabetic eye disease needs careful attention, as serious cases may lead to significant vision loss and even complete blindness. More frequent exams are needed for patients with existing diabetic eye disease. Early diagnosis is critical in management of diabetic eye disease. We use the Carl Zeiss Visucam pro fundus camera, with fluorescein angiography capability, to aid in the diagnosis and management of diabetic eye disease. We also employ the stratus OCT (Optical Coherence Tomography) which provides a higher level of diagnostic insight. Using near-infrared frequency light, it reveals a cross-sectional view of the retinal layers with very high resolution, thus detecting and localizing early lesions. Some patients may require laser retinal therapy or surgical intervention to stop the progression of advanced diabetic eye disease.
Glaucoma Management and Treatment
Glaucoma is a complex disease that causes gradual diminution of the peripheral vision over many years. Advanced cases may ultimately affect the central vision, resulting in blindness. The key to management of glaucoma is early diagnosis and treatment. The eye pressure, optic nerve appearance, and thickness of the optic nerve fiber play important roles in the progression of glaucoma.
We employ the latest technologies in the diagnosis and treatment of glaucoma:
Visual Field Testing for Glaucoma Humphrey Zeiss 700 series visual field testing is one of the fastest, and most accurate methods for mapping the peripheral and central visual fields to detect early changes consistent with glaucoma. Tonometry, Tonopen Pressure Measurement Intraocular pressure measurements are performed by experienced personnel using Goldmann applanation tonometry or Tonopen tonometers. We do not use “air puff” methods as they are more uncomfortable for patients, and are not as accurate as the above methods. Corneal Thickness (Pachymetry) measurements will determine the accuracy of the intraocular pressure measurements in correlation to each individual cornea. Ultrasound pachymetry is a painless, and accurate method of determining the corneal thickness. Pachymetry can also be determined in an optical method (no touch) using the Stratus OCT (Optical Coherence Tomography). Opric Nerves Fundus photography using the Carl Zeiss Visucam will document the appearance of the optic nerves for serial comparisons over periods of time. This will help to determine stabilization or progression of the disease and response to therapy. Optic nerve fiber analysis by Stratus OCT (Optical Coherence Tomography) provides a higher level of diagnostic insights. Using near-infrared frequency light, it reveals cross-sectional views of the optic nerves and its fibers with high resolution. Computerized comparisons are graphed and compared to age-matched normative data.
There are different types of glaucoma:
Primary Open Angle Glaucoma: This is the most common type of glaucoma in the United States. The cause is presumed to be a microscopic obstruction of the drainage system of the fluids circulating in the anterior compartment of the eye. The intraocular pressure is usually high, with abnormal optic nerve appearance and peripheral visual field defects consistent with glaucoma.
Narrow Angle Glaucoma: This is more common in patients of Asian origin or in high degrees of hyperopia (far-sightedness), where the anterior compartment of the eye is crowded with structures causing mechanical obstruction of the drainage site of fluids circulating in the eye.
Glaucoma Suspects: This is a term given to patients who have a suspicious optic nerve appearance, yet all other parameters and testing are normal. Glaucoma suspects are statistically at a higher risk than normal individuals for developing primary open angle glaucoma. Stratus OCT testing helps in determining high risk glaucoma suspects, and prophylactic treatment may be instituted in these cases.
Ocular Hypertension: This is a term given to patients with elevated eye pressure, yet all other parameters and testing are normal. Corneal pachymetry and Stratus OCT testing help in determining high risk ocular hypertension patients, and prophylactic treatment may be instituted in these cases.
Treatment of glaucoma:
Selective laser trabeculoplasty (SLT): Is the latest, state-of-the art technology to control glaucoma. A less than 5 minute, relatively painless and simple in-office procedure that utilizes a laser beam to improve the outflow (drainage) and hence control glaucoma. It is safely repeatable, and is effective in 60-95% of patients according to the type and severity of glaucoma.
Many patients are controlled with medical therapy using topical drops. There are many classes of drops; some reduce the production of acquous (fluid) in the eye, and others try to improve the drainage. Some glaucoma drop regimens can control glaucoma with once daily dosing at bed time. Others may require twice or three times daily dosing.
Glaucoma filtration surgery:
This is considered a last resort, if glaucoma cannot be controlled by medications or laser. There are different types of glaucoma surgical procedures. The most commonly performed, trabeculoplasty, creates a channel that drains the fluid from inside the eye to the outside under the conjunctiva (the skin of the eye). A medication called Mitomycin-C is commonly used during this procedure to prevent postoperative scarring and closure of this channel. More involved procedures include using “Seton devices”, or synthetic tubes that drain the fluid from inside the eye to to the outside. This is reserved for advanced types of glaucoma.
Floaters & Flashers
Floaters and flashes can be warning signs signaling a more severe problem in your eye, including retinal tears and detachments. The central cavity of the eye is filled with a gel-like substance called the vitreous humor. Floaters are small clumps of cells, pigment, and or gel matrix, which “float” inside the vitreous. Floaters often appear as if they are floating in front of the eye, and sometimes imitate a swarm of small insects. A shower of new floaters signifies a problem that requires prompt attention and you should see Dr. Tinoosh immediately. Typical floaters are not usually treated. If the floaters have been caused by a posterior vitreous detachment without a retinal tear, the floaters will typically “settle” out of the line of vision over several weeks to months. Severe floaters caused by a vitreous hemorrhage that does not clear after several months and prevents useful vision can be removed surgically by a pars plana vitrectomy.
Flashes are the experience of brief sensations appearing to be bright lights at the edge of vision. Flashes are usually noticed all the way to one side and are more prominent in the dark or when going from a well-lighted area to a darker area. The experience of flashing lights, especially in conjunction with new floaters, can be an indication of a posterior vitreous detachment, retinal tear, or a retinal detachment. The flashing lights represent the release of an electrical signal from the nerve tissue of the retina when there is pulling on the retina from a vitreous gel that is separating from the retina. Any experience of new flashes should be reported to your ophthalmologist and he or she will usually perform a prompt dilated exam of the retina.
If you are experiencing new flashes, it is important to undergo a dilated exam of the eye with a careful exam of the far peripheral edge of the retina. It is at this very edge of the retina, which is thinner than the more central part of the retina, where most retinal tears occur. If no retinal tear or retinal detachment is found, then no treatment is usually indicated. After the initial exam, it is helpful for you to screen yourself periodically by carefully observing the world around you with one eye at a time. Look for new symptoms such as increased floaters, new or increased flashes or flash intensity, or a shadow. If any of these additional symptoms occur, you need to return to Dr. Tinoosh for a repeat dilated exam, immediately. Also, external laser can sometimes be used to achieve this result, if the view for the laser is sufficient.
Glasses & Contact Lens
Glasses (provided by Altair)
For your eye health and comfort, it is important that you select the right lenses for your new glasses. Whether you work at a computer a lot, need help reading, play outdoor sports, or just can’t see the road signs clearly…Dr. Tinoosh will help you determine the best lenses for your needs. We have a selection of lenses that offer state of the art technology and are thin, lightweight and easy to care for. Say goodbye to heavy, thick glasses that are uncomfortable and say hello to today’s thinner, lighter lenses. Lenses and coatings from Essilor and photochromics from Transitions are today’s best choices and are available here. When wearing the right lenses paired with a stylish set of frames, you will not only see and feel better, you will look better! With the broad selection of frames, you can make a bold, high fashion statement with your glasses or be as understated as you like. We carry the fine quality frames, as well as sunglasses.
A contact lens is a corrective, cosmetic, or therapeutic lens usually placed on the cornea of the eye. People choose to wear contact lenses for many reasons, often due to their appearance and practicality. When compared with spectacles, contact lenses are less affected by wet weather, do not steam up, and provide a wider field of vision. They are more suitable for a number of sporting activities. A corrective contact lens is designed to improve vision. For many people, there is a mismatch between the refractive power of the eye and the length of the eye, leading to a refraction error. A contact lens neutralizes this mismatch and allows for correct focusing of light onto the retina. Contact wearers must usually take their contact lenses out every night or every few days, depending on the brand and style of the contact. Complications due to contact lens wear affect roughly 5% of contact lens wearers each year. Excessive wear of contact lenses, particularly overnight wear, is associated with most of the safety concerns. Problems associated with contact lens wear may affect the eyelid, the conjunctiva, the various layers of the cornea, and even the tear film that covers the outer surface of the eye. We offer a wide variety of brands to everyone needs.
Kamra Inlay Procedure
The Kamra Inlay Design is primarily geared to treat patients whose near vision capabilities have decreased over time. Also known as presbyopia, the condition itself is very common and has often been rectified via prescription eyeglasses or contact lenses. More recently, however, a newer technological breakthrough has enabled ophthalmologists to correct this condition with the Kamra Inlay Design, which is both intricate and highly effective. A more natural range of visual acuity can be achieved, as the procedure has proven to be safe and longer lasting than any other optical corrective solution of its kind.
The inlay itself is smaller than a contact lens and is inserted into the non-dominant eye only. The treated eye will then be able to see up close and maintain mid-range vision as well, while the dominant eye will be adjusted for greater distance vision. With both eyes working in unison, the results of this procedure have been documented as quite impressive. Comparable to a film-like ring with a small opening at the center, an aperture is created, which is a tiny hole or opening thru which light travels. Only focused light is allowed to travel through the specialty lens, thus increasing focus and depth perception. Being able to see clearly up close, at median range, and/or longer distances is also attainable after having the Kamra Inlay Design procedure performed. One of the reasons why this procedure is extremely effective has to do with the outer ring, which contains 8400 microscopic openings. As a result, more oxygen, enzymes and other nutrients are able to travel freely through the corneal area; increased oxygenation is a very important part of sustained eye health in general, which is why this procedure works very well in a majority of patients. Because the inlay is an actual implant, patients will not be able to feel it while blinking or otherwise, as opposed to contact lenses that can cause problems due to excess friction. Prime candidates for the Kamra Inlay Design are usually between the ages of 40 and 60, and some restrictions may apply. Those who’ve undergone cataract surgery may not be eligible, yet consulting with an eye specialist and/or having a complete eye examination is strongly recommended. In some cases, the cornea may be too thin in order to have the Kamra Inlay surgery executed effectively.
During the first three to six months following the surgery, side effects may include blurred vision, seeing halos, experiencing glare, and dryness or burning in the eye. Corneal swelling has also been known to occur, as well as mild to moderate pain. It’s also important to adhere to doctor recommended follow-ups in order to avoid any possible complications.