Services

Urgent Care for Ophthalmic Conditions

An Eye Institute of Austin physician is on-call each day and after hours for our patients that have an urgent eye care need. Patients are encouraged to call our office and speak with a technician to find an appropriate time to meet with our physicians. We triage our calls and in some cases it is not necessary to be seen immediately. In such cases, a doctor will be consulted for suggestions, and the next available appointment with your doctor will be scheduled in case the proposed plan of action did not resolve your problem.

With few exceptions, these evaluations are all considered MEDICAL problems and will be filed under medical insurance. Most VISION insurance plans only cover specific normal eye exam services and not problems or emergency care. If you are experiencing problems after normal business hours (8AM – 5PM, Monday – Friday), our answering service will answer your phone call and contact the physician on-call. That physician will call you to address any problems you are experiencing. If you have to be seen in the office “after hours” special fees will apply.

We welcome our patients to call with any concerns or questions about their eyes so that our staff and physicians can promptly address them. We especially encourage our post-operative patients to call with any unusual developments so they can be assessed quickly and managed effectively during this critically important period of time.

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Evaluation for High-Risk Medication Usage

Some medications have been shown to carry risk for vision alteration. We usually see these patients in conjunction with a complete eye exam, with several additional tests that may be helpful in assessing the status of one’s vision such as: visual field testing, ocular coherence tomography, corneal topography, depth perception, and color vision testing. These tests are performed by a technician and interpreted by your physician. A report letter is sent to your medical physician who prescribes the high-risk medication. Plaquenil is the most common medication in use that requires regular visual function screening.

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Cataract Evaluation and Surgery

Cataract evaluation is done either during a regular complete eye exam or by specific patient referral. A cataract is an opacification or clouding of the crystalline lens within the eye, which may prevent a clear image from forming on the retina. Common symptoms from cataracts include blurred vision, glare complaints and difficulty with nighttime vision. Most adults will develop some signs of cataract formation, and in cases where the symptoms affect or interfere with one’s daily routine, treatment can be beneficial to reverse the cataract-related vision loss. All cataracts are treated with a minimally invasive surgical procedure by removing the cataractous lens and placing an intraocular lens implant within the eye. Several measurements of the eye are obtained in the office to help select which lens implant will be used in surgery. While surgery has an exceptionally high success rate, it is still important to discuss the proposed treatment with your physician to determine if cataract surgery is an appropriate procedure for you.

Dr. Gary R. Rylander, Dr. R. Todd Smith, and Dr. Steven H. McKinley are our physicians who perform cataract surgery.

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Corneal Evaluation and Treatment

Our clinic offers a wide range of expertise regarding corneal disease management. All of our general ophthalmologists can diagnose and treat most corneal diseases. Dr. Gary R. Rylander, who is a cornea-trained specialist, is available for consultation on complex corneal disease cases and also performs corneal transplantation surgery. Below is a list of some of the main corneal diseases that we manage:

  • Bullous Keratopathy- a degenerative process in which the cornea swells with blister-like elevations on the surface that may reduce vision and cause painful corneal surface erosions. If a patient is very symptomatic, cornea transplant surgery may be helpful.
  • Cornea Transplant Surgery-- a procedure that replaces scarred or diseased corneal tissue with clear corneal tissue from an organ donor.
  • Corneal Abrasion-- a scraped area on the corneal surface which may cause a painful foreign-body sensation.
  • Corneal Ulcers-- lost areas of the outermost layers of the cornea accompanied by an inflammatory response. May be caused by auto-immune diseases, or bacterial, fungal or viral infections often related to improper contact lens usage.
  • Dry Eye Syndrome-- characterized by dryness of the ocular surface due to decreased tear production or increased tear loss. Common eye symptoms include a foreign body sensation, burning, irritation or redness. In some cases it may result in decreased or fluctuating vision.
  • Foreign Body Removal-- in cases of ocular trauma, material may be deposited on or embed into the surface of the eye. This causes a foreign body sensation and poses a risk for infection. Removal of the foreign body is the treatment.
  • Fuchs’ Dystrophy– a common hereditary condition in which microscopic deposits of material collect on the back surface of the cornea. It may produce corneal clouding or swelling which can lead to blurred vision.
  • Keratoconus– a pathological condition characterized by thinning and a cone-shaped protrusion of the central cornea, usually in both eyes. It may cause significant blurring of vision and requires special contact lenses for management or in some cases, corneal transplantation surgery.

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Glaucoma Evaluation and Treatment

Glaucoma is a group of diseases characterized by progressive optic nerve damage, which can cause loss of the field of view for each eye. Since glaucoma damage can occur without any symptoms and is more likely to develop as a person ages, it is important to periodically undergo screening for the condition. Glaucoma damage is permanent but controllable or preventable with appropriate treatment. All current practice treatments are aimed at reducing the pressure within the eye to halt or limit the optic nerve damage caused by glaucoma. This can be achieved with topical eye medications, laser procedures, surgery, or any combination thereof. Our patients with glaucoma require closer monitoring and more frequent examinations than the majority of our patients. All of our ophthalmologists are capable of screening for, diagnosing, and treating glaucoma. Dr. Steven H. McKinley is a fellowship-trained glaucoma specialist who is available for consultation on more challenging cases that may require a surgical intervention. Below is a list of some tests and procedures used for glaucoma care that are available at our office:

  • Visual Field Test-- an automated test that measures the extent of the area visible to an eye by having the test eye fixate on a central target; useful for determining the degree of glaucoma damage and for monitoring stability of the disease.
  • Optical Coherence Tomography– a non-invasive test which uses light waves to measure retinal nerve fiber loss and provide an anatomic analysis of the optic nerve; a helpful test for monitoring glaucoma progression when used in conjunction with the visual field test.
  • Peripheral Iridotomy-- an in-office laser procedure used to create a small hole in the iris near its base. Indicated for the treatment of narrow-angle or angle-closure glaucoma, cases where the intraocular pressure may rise quickly and drastically leading to rapid glaucoma damage.
  • Laser Trabeculoplasty-- an in-office laser procedure used to enhance the natural drainage of aqueous humor (the fluid within the eye) in an attempt to reduce the intraocular pressure.
  • Trabeculectomy and Glaucoma Drainage Implant (“Tube Shunt”) Surgery– Dr. McKinley performs these glaucoma surgeries at Bailey Square Surgery Center (34th Street) and Medical Park Tower Surgery Center (West 38th Street). Surgery tends to be indicated in advanced glaucoma or if glaucoma is uncontrolled despite medical and/or laser treatment.

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Vitreoretinal Disease Management

The vitreous (a gel-like substance that fills the eye) and the retina are located in the back of the eye. All of the physicians at the Eye Institute of Austin can perform retinal examinations. However, a retina specialist will be seeing patients out of our office every three weeks for more thorough examinations and for the convenience of our patients with more serious retina needs. Examples of diseases that may affect the vitreous and retina are:

  • Diabetic Retinopathy-- a series of progressive changes in the retina characterized by bleeding (dot-blot hemorrhages), swelling (macular edema) and abnormal blood vessel growth (neovascularization.) This can occur in long-standing diabetes or if diabetes is not well-controlled. Diabetics are advised to have an eye examination on a yearly basis to screen for these abnormalities and a letter will be sent to your diabetes doctor to report on the status of your eyes.
  • Age-Related Macular Degeneration-- the deterioration of a specific region of the retina (the macula) responsible for sharp, clear central vision. The “dry” form of the condition is detected by a disturbance in the pigmentation of the macula or by the presence of yellowish deposits just beneath the retina (called drusen.) In the “wet” form, abnormal blood vessels grow beneath the retina which leak fluid and blood and alter the normal functioning of the macula. Macular degeneration is the leading cause of irreversible vision loss in this country. Our physicians can discuss with you the role of nutritional supplements or retina treatments in caring for macular degeneration.
  • Macular Pucker/Epiretinal Membrane– wrinkling of the central retina (the macula) caused by contraction of a thin membrane on the retinal surface which may produce distortion of vision. Surgery to remove the membrane is sometimes recommended to improve vision.
  • Posterior Vitreous Detachment– separation of the vitreous gel from the retinal surface as it liquefies and condenses over time. Usually a harmless change that produces new flashes of light or “floaters” in one’s vision, but may lead to a retinal detachment in complicated cases. Prompt examination of any new flashes of light or “floaters” is strongly encouraged to exclude a retinal detachment.
  • Retinal Tear or Detachment– a separation of the retina from the inner layers of the eye which can disrupt vision and cause loss of areas within the visual field. Often requires immediate surgical repair.

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Contact Lens Department

Contact lens fitting and evaluation — Cheryl is the contact lens specialist and based on her expertise and the prescription given by our doctors she will fit you in a lens that you feel most comfortable wearing. There is a contact lens dispensing and fitting fee which will be determined after assessing your contact fit and type of lens you will most likely need. This fee covers diagnostic lenses needed as well as any visits necessary to evaluate the vision and fit of the lenses for three months following your exam. As with all cases you, your doctor, and Cheryl will work together to determine which is the best type of lens for your eyes.

Soft contact lenses– Are made from Silicon Hydrogel materials which retain moisture and allow more oxygen to the cornea than lenses of the past. Some are meant to be replaced daily while others are removed nightly and replaced on a two week or monthly schedule dependent on type of contact lens that you are wearing. There are also extended wear contact lenses that can be worn eight hours the first day and increased by adding two hours each day. But, our doctors are very conservative about fitting these so they are not recommended for all patients. There are several different types of soft contacts that are available and are listed below:

  • Spherical — These lenses are corrected for distance vision only.
  • Toric – These lenses are made from the same materials as spherical lenses. The difference is in the design of the lens. Toric lenses have two powers: one for astigmatism and the other for myopia or hyperopia. There is also prism in the lens to help keep the lens relatively stable in your eye. Years ago most everyone with astigmatism were prescribed a gas permeable lens. Thanks to newer technology we now have more options.
  • Bifocal & Multi-focal — These lenses work in several different ways depending on the design of the lens. Bifocal lenses have two powers correcting for distance and near vision. Multi-focal lenses have more than two powers and typically correct for distance, near, and mid-range vision.
  • Mono vision — These lenses are for patients who need near correction, one eye is corrected for distance vision (usually the dominant eye) and the other eye is corrected for reading correction or is “under-corrected” (usually the non-dominant eye). One eye takes over to see at distance while the other does so at near.
  • Gas permeable lenses — Are made of special plastic that allows for the passage of oxygen and other gasses. These lenses are very durable and give you the crispest vision. These lenses are often recommended for patients with very high astigmatism or other corneal diseases that require more specific fit than soft lenses offer. These lenses take longer to get used to and new wearers have to ease into wearing these lenses by wearing for short periods and lengthening wear time as you become used to them.

Keep in mind anytime we are correcting distance and near vision it will be less than perfect. Reading glasses will no doubt be needed over the contacts for smaller than normal print or in a low light situation. These types of fitting require patience and motivation and may require several visits.

*Contact lenses are classified as medical devices by the U.S. Food and Drug Administration. Click Here for more information.

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Optical Department

Armando and Jodie are ABO (American Board of Opticianry) certified opticians with 40+ years experience between the two.

At the Eye Institute of Austin you have the choice and convenience of filling your eyeglass prescription in our in-house optical. Armando and Jodie are here to help you fill your eyeglass prescription and can assist in choosing the right frame, lens, and coating that suits your lifestyle.

Frame styles vary from light weight, flexible, strong and hypoallergenic. Some name-brands offered: Silhouette®, Flexon®, Marchon®, Calvin Klein®, and Maui Jim®.

Eyeglass lenses are made from various materials: Glass, plastic, high-index, polycarbonate, and trivex. High Definition lenses are offered as well. All have their advantages in durability, weight, and thickness. Our opticians will use their expertise in helping you decide the best materials for your needs.

The normal aging process causes us to lose the ability to focus on objects up close. This is known as Presbyopia. Most people will notice this start to set in around the age 43. The addition of a bifocal in your eyeglass prescription can help with this. Others may need a trifocal. And some choose to go with a progressive lens. Our opticians can discuss your options and needs in detail if you fall into this category. Some presbyopic people only need a single vision near lens to assist with reading. These are typically called “readers” and are available in our optical.

Lens coatings can enhance and protect your vision. Lens coatings range from anti-reflective, scratch resistance, and UV protection. Our opticians will be glad to discuss what options will suit you best.

Minor frame repair is available in our optical by our experts.

Armando and Jodie are committed to meeting your optical needs with expertise, consideration and no-hassle.

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