January is Glaucoma Awareness Month, and in this month we dive into aspects of glaucoma care to help our patients. To learn more about general facts about glaucoma, please refer to the article from 2024. In this post, we will touch on the different types of treatments available for glaucoma. In glaucoma, eye pressure damages the optic nerve and leads to irreversible vision loss. The goal of glaucoma treatment is to lower the eye pressure. This can be accomplished in several ways: eye drops, procedures, and surgeries. Each has its advantages and disadvantages. The treatment of glaucoma is highly personalized and different treatments apply to different patients. The most straightforward and often first line treatment of glaucoma involves the use of eye drops . There are multiple classes of eye drops, and each has its own set of side-effects that are taken into account when providing recommendations to patients. Eye drops are typically used anywhere from one to three times daily. As glaucoma advances, the eye pressure may respond less well to eye drops and require additional treatments, such as procedures or surgeries. Procedures for glaucoma involve lasers and injections. Laser treatment varies depending on the type of glaucoma. The most common form of glaucoma, termed open-angle glaucoma, occurs when the natural drain in the eye does not function well. One cause of this poor function occurs due to a clogging of the natural sieve that filters out the fluid in the eye, called the trabecular meshwork. For this form of glaucoma, a laser may be used to clean this sieve, a procedure called trabeculoplasty. Trabeculoplasty has been in use for decades, supported by a well established scientific literature. In fact, it is now recommended as first line therapy in many instances. The second form of glaucoma, angle-closure glaucoma, occurs when the natural drain is blocked. A different laser procedure, called an iridotomy, attempts to relieve this blockage. A relatively new procedure involves the injection of a medication into the eye , whereby it slowly dissolves over a period of months. This injection effectively acts as a substitute for an eye drop and may be beneficial in patients who do not tolerate eye drops well. Sometimes, eye drops and procedures are not enough to control the eye pressure, and the eye remains at risk of vision loss. In these cases, surgery may be required. Surgery can be divided into minimally invasive glaucoma surgeries (MIGS) and traditional surgeries. MIGS, often performed at the time of cataract surgery, try to rehabilitate the natural drain in the eye. These involve the use of stents and other instruments to open the natural drain. Sometimes, even these surgeries are not enough, and the use of traditional surgeries is required. In these cases, the natural drain cannot be rehabilitated, and a bypass procedure is performed, whereby a tiny window is created in the eye to allow the fluid to exit the eye and lower the eye pressure. There are two variants of this procedure: in one, the tiny window is created and left as is, and in the other, a small tube is inserted into the tiny window. The treatment of glaucoma has evolved over many years and now encompasses a wide variety of therapies that allow for a personalized approach. And fortunately, for the great majority of patients, appropriate treatment can slow or stop the progression of glaucoma. If you have any questions or concerns about glaucoma or its treatment, we here at the Glaucoma Center at NJ Eye and Ear, consisting of myself, Dr. Khelly Savant, Dr. Nahndi Bush , and Dr. Daniel Stegman , are always available to assist you in making decisions regarding your glaucoma care.

Eat Pistachios for Better Eye Health

Dry eye disease is a prevalent and sometimes debilitating condition due to inadequate lubrication or rapid evaporation from the surface of the eye. It can cause blurry vision, discomfort, redness, and a chronic gritty sensation. The prevalence of dry eye disease in the United States is estimated to affect over 16 million adults. This might be an underestimate, as many people may not seek medical attention for milder symptoms. The impact of dry eye disease is more than simple discomfort; it can impair many daily activities such as reading, driving, and working on a computer. It is considered a chronic pain condition and can deteriorate one’s quality of life. Causes of dry eye can be numerous, including even a fan, heater, or air conditioner near your bed while sleeping. Wearing contact lenses or prolonged computer and cellphone use can also be culprits. Lastly, eye surgeries, such as LASIK and cataract surgery, are known to worsen dry eye symptoms. Patients undergoing these procedures are advised to optimize their dry eye before surgery to minimize issues afterwards. Addressing any dryness before surgery is also critical for the ophthalmologist to get the most accurate measurements for the best chance at good vision after surgery. The good news is, with proper management before and after surgery, the symptoms of dry eye can be minimal to none. There are various treatments for dry eye and they must be customized for every patient depending on the severity. Initial therapies can include over-the-counter medications, such as artificial tears that can relieve symptoms by lubricating the surface of the eye. If these do not adequately control symptoms, prescription medications, such as cyclosporine (Restasis) and lifitegrast (Xiidra) among others, can be used to increase natural tear production and reduce inflammation on the surface of the eye. For some individuals, even these treatments are not sufficient however. This can be due to underlying medical conditions, such as Sjogren’s disease or thyroid imbalances. These patients and others who are dissatisfied with their symptoms can benefit from treatments such as amniotic membrane application. These can protect the cornea, reduce inflammation, and promote regeneration of the eye’s surface. For those patients struggling despite consistent use of eyedrops, these and other therapies can be game changing. Thankfully, there are a multitude of treatments available to alleviate dry eye. With a comprehensive and tailored approach from an eyecare specialist, your dry eye symptoms can be better by next July.

January is Glaucoma Awareness Month , and as a glaucoma specialist, this month holds special importance to me as a physician dedicated to preventing vision loss from glaucoma. I am also a member of the American Glaucoma Society Patient Care Committee, dedicated to improving patient education, outreach, and advocacy. Glaucoma is an eye disease that affects millions of Americans, in which the optic nerve, the nerve that connects the eye to the brain, suffers damage. After a critical amount of optic nerve fibers are damaged, the vision becomes affected. The causes of glaucoma are still being actively researched, though we know that eye pressure plays a significant role in the condition. In fact, nearly all therapies for glaucoma work by lowering the eye pressure. Importantly, simply having high eye pressure does not equate to having glaucoma, in a similar way to how simply having high blood pressure does not equate to having heart disease. Another significant risk factor for glaucoma is age, though rarer forms can affect younger individuals. Unfortunately, the damage that occurs to the optic nerve, and the resulting vision loss, is irreversible. In addition, glaucoma typically affects the peripheral vision first, and it progresses slowly. For this reason, a person may not know that they have vision loss from glaucoma until much later in the disease course. It is no surprise that glaucoma is thus known as the “silent thief of sight.” This is very different from a condition such as macular degeneration, which typically first affects the central vision that we use to read. Patients with vision loss from glaucoma may begin to bump into objects and may not be able to see their feet as they walk. Driving and other complex activities may become difficult or unsafe. Fortunately, with proper care and treatment, the progression of glaucoma can be slowed or halted. In the last decade, there has been an explosion in minimally invasive surgery, which is able to decrease the rate of vision loss with far fewer risks than with traditional glaucoma surgeries. New classes of medications have been made available, and refinements to the traditional surgeries have been devised. There are numerous research groups investigating neuroprotective therapies, which may offer a new way to treat glaucoma by protecting the optic nerve against damage. And, lastly, though likely still a long while away, regenerative therapy to reverse optic nerve damage is being studied, as well. It is important to ask your primary care physician or your primary eye doctor if a glaucoma evaluation is indicated, especially if you feel that your peripheral vision has worsened or if you notice gray, blurry, or black areas in your vision. A glaucoma evaluation often requires only a few additional examinations and tests. The Glaucoma Division at NJ Eye and Ear, consisting of myself, Dr. Khelly Savant, Dr. Nahndi Bush, and Dr. Daniel Stegman, is always here to answer any questions, as we work together to prevent vision loss and preserve our patients’ quality of life.

Why is my child’s eyesight getting worse every year? Most parents of near-sighted or myopic children will experience having to get new glasses every year due to the prescription getting worse as the child gets older. This is a very common and expected pattern of myopia for most children, and for many years, new glasses every 6 months or every year was the only solution. In the last few years, there has been many advances in the world of myopia, especially pediatric progressive myopia. But first, let’s go over the basics. What is Myopia? Myopia is nearsightedness, which means that you can see close objects, but objects farther away appear blurred. Myopia occurs if the eyeball is too long or the cornea (the clear front cover of the eye) is too curved. As a result, the light entering the eye isn’t focused correctly, and glasses or contact lenses will correct the blur. What is Myopia Control? “Myopia Control” is a term used to describe specific treatments to slow the progression of nearsightedness in children. What is offered at New Jersey Eye and Ear for Myopia control? 1. Ortho-Keratology hard lenses 2. MiSight soft contact lenses 3. Atropine 0.02% eye drops Information on the current Myopia Controls Ortho-Keratology (Paragon CRT lenses) Ortho-Keratology uses a series of custom-fitted hard contact lenses to temporarily reshape a child’s cornea. When the lenses are worn nightly, children with myopia can see clearly the next day without needing eyeglasses or contact lenses. When the child stops using the lenses, the cornea will go back to its original shape and myopia returns. Multiple studies suggest Ortho-Keratology lenses slow the eye’s growth by nearly 53%, effectively slowing down the progression of myopia. Wearing any lenses overnight can increase the risk of infection, therefore, they require thorough cleaning and extra hygiene steps compared with disposable lenses. MiSight Lenses (Coopervision) MiSight lenses are the first FDA-approved contact lenses for controlling myopia progression in children. These are soft, disposable lenses that are worn during the day, and discarded at night. Patient cannot sleep in these lenses. MiSight lenses have concentric rings to redirect how light hits the retina, which tricks the eye into not growing too long. The studies show that MiSight lenses are effective in slowing myopia progression in children by 59%. To get the full recommended benefit, children must wear the MiSight lenses at least six days a week, for 10 hours a day, until they are teenagers. Like all standard lenses, Misight lenses pose a risk for corneal infection. Good contact lens hygiene can lower this risk. Atropine 0.02% Eye Drops Atropine 0.02% eye drops is clinically used to prevent the progression of myopia by strengthening the sclera (white portion of the eye) to make the eye more stable and prevent elongation. The child still has to wear eyeglasses during the treatment to see clearly. Atropine 0.02% eyes drops dosage would be 1 drop in both eyes daily. There are some side effects of stinging, blurred vision or pupil dilation. There is at least a 2-year commitment before any attempts to discontinue the eye drops after stabilizing the refractive error. The drop will not be available at any pharmacy since it has to be compounded for its specific dosage. The prescription will be sent to a compounding pharmacy, and the pharmacy would dispense the drops and assist patient with details on insurance coverages if available. Optometrists that provide these treatments: Dr. Jessica Lee (Englewood Location) Dr. Ester Kohen (Clifton and Englewood Locations) These therapies work differently for every child, so please ask your doctor which would be the most recommended and effective therapy option for your child. Many parents believe their child is “too young” for contact lenses. However, research has shown that both children (ages 8-12) and teenagers (13-17) can safely wear contact lenses. NJ Eye and Ear Contact Lens Department will train with all first time contact lens wearers. Over a three-year period, evidence has shown a statistically significant improvement in self-perception regarding physical appearance, athletic competence, and social acceptance in children wearing contact lenses.

In this episode, Dr. Kaleem speaks with Dr. Larry (Lawrence) Geyman about different types of visual changes that patients with glaucoma can experience, such as changes in contrast sensitivity, motion sensitivity, and visual crowding. To listen now CLICK HERE

Spread Cheer, Not Infection.....

NJ Eye and Ear is proud to celebrate 25 years in business serving the northern New Jersey area under the leadership of Daniel Stegman, MD. NJ Eye and Ear is a progressive, learning-oriented medical practice specializing in treating all manners of ENT, vision and hearing problems. The practice’s goal is to provide the most advanced and cost-effective care to its patients. To that end, NJ Eye and Ear has built a team of the top award-winning physicians and surgeons, encompassing all sub-specialties of ophthalmology, otolaryngology and audiology. NJ Eye and Ear provides eye examinations, allergy testing, ENT problems, and hearing exams. It also offers laser-vision correction, treatment of retinal diseases, clogged tear ducts, cataract, and facial cosmetic surgery to name a few. “We are pioneering at the forefront in health care with state-of-the art equipment and the most fashionable eye boutique in New Jersey,” said Rey Bolic, spokesman for NJ Eye and Ear . With over 25 years of experience in the field, Dr. Daniel Stegman provides comprehensive ophthalmologic care and the treatment of glaucoma. He is widely known and respected for the high quality of care that he provides. At Mount Sinai he completed a clinical and research fellowship in glaucoma, and remains on staff as a clinical instructor of ophthalmology. Dr. Stegman’s research work in glaucoma has been presented at the prestigious Association for Research and Vision in Ophthalmology. He is fluent in Spanish and English, and is also an NYPD Honorary Police Surgeon. Dr. Kevin Ende is double board-certified and has performed over 14,000 ear nose and throat, facial plastic and reconstructive, and hair restoration surgeries over the last 17 years in New York City and Philadelphia. In 2019, Dr. Ende was recruited to head the ENT division of NJ Eye and Ear in Englewood. Dr. Ende has served as a faculty member for the Department of Otolaryngology at the University of California, San Francisco (UCSF), where he taught advanced techniques to surgeons in training. For the past 9 years, Dr. Ende has trained the ENT residents from the highly respected Albert Einstein/Montefiore training program in Bronx, N.Y. Dr. Ende is established as a leading hair restoration specialist in the New York and New Jersey area. Dr. Daniel Chechik is a board-certified ophthalmologist, specializing in retina care and treatment. Dr. Chechik gave back to his community through teaching at SUNY Downstate Health Science Center and Lebanon Hospital where he was an assistant professor. Dr. Chechik completed his residency in 2001 and continued on to complete a fellowship in surgical and medical disorders of the retina and vitreous. He is fluent in Russian, Spanish and Dr. Nahndi Bush has devoted more than 18 years to the practice of comprehensive ophthalmology and glaucoma in northern New Jersey. Following internship at Hackensack University Medical Center, Dr. Bush completed her ophthalmology residency at Mount Sinai Medical Center in New York then stayed on as chief resident, completing a glaucoma fellowship. She serves as a voluntary attending at University Hospital in Newark, where she was recently honored with the 15-year Service Award. Dr. Nirupa C. Cuttler is a comprehensive board certified ophthalmologist who provides a wide array of ophthalmic care. She was raised in central New Jersey and stayed in the state for her undergraduate and medical training. She then went to Royal Oak, Mich. to complete her internship year and ophthalmology residency at William Beaumont Hospital, where she served as chief resident during her last year. She is proficient in Spanish and fluent in Tamil (South Indian language). Dr. Tal Kazam is a board-certified comprehensive ophthalmologist providing a wide spectrum of eye care. She completed her ophthalmology residency at the renowned New York University and Manhattan Eye, Ear and Throat Hospital. Before joining NJ Eye and Ear, Dr. Kazam was in private practice in New York City. She is licensed to practice medicine in New York and New Jersey. Dr. Gautam Kamthan is a board-certified medical and surgical comprehensive ophthalmologist who has been in practice for nearly 10 years. In addition to laser and refractive cataract surgery, he has a particular interest and expertise in high-risk cataracts, the repair of complications from cataract surgery and reconstruction of the front of the eye. He is an assistant professor at the Mount Sinai Medical Center and the New York Eye and Ear Infirmary. He treats veterans at the James J. Peters Veterans Affairs Medical Center in New York City, and has an affiliation with Holy Name Medical Center in New Jersey.

Getting the flu vaccine can decrease your chances of getting sick with flu. Studies have shown that flu vaccination can reduce your risk of contracting influenza virus. If you do happen to get sick and you are vaccinated, studies have shown that the severity of your illness is reduced. Furthermore, the risk of being hospitalized and dying from flu are also decreased.