Overview of services offered at UVA eye clinic
The Ophthalmology Department consists of nine (9) full-time faculty and eight (8) part-time faculty. The General Eye Clinic is organized and staffed by the residents. We offer the following clinical services:
Staffed by residents and faculty, this service provides primary eye care and various surgical procedures including cataract, glaucoma, and retina surgeries to patients and referrals from other Medical Center clinics. It also provides care for urgent conditions that present through the Emergency Department.
One of the major missions of this service is providing care to the underserved through a financial screening program provided by the Hospital.
This service offers contact lens fitting for various ocular conditions, ranging from soft contact lens for simple refractive disorders to rigid gas-permeable lenses for complex corneal disorders such as keratoconus and corneal transplant patients. An extensive collection of gas-permeable and soft contact lens trials are available in inventory.
Dr. Bruce Carter, a part-time faculty member, head the Pediatric Ophthalmology Service together with Dr. Christian Carter. They perform various types of pediatric strabismus, cornea, and glaucoma procedures including endoscopic cyclophotocoagulation. They spend one full day a week with the residents in the operating room and the clinic and maintain a strong commitment to clinical teaching.
This service provides diagnostic services for ocular conditions affecting the eyelids, conjunctiva, cornea, globe and orbit. In collaboration with neuropathy, dermatopathology, cytology, and other pathology services in the hospital, this service handles various ocular, orbital, and adnexal specimens. Services offered range from routine light microscopy to specialized immuno-histochemistry and electromicroscopy.
Extensive cutting edge technologies are also available in this service through the Department of Pathology and core facilities at the hospital.
Cornea, Anterior Segment & External Disease
This consulting service provides care for patients with all types of corneal and external ocular diseases. We perform high risk corneal transplants including the latest endothelial replacement procedures. Computerized corneal topography and Pentacam imaging is used in the analysis and management of patients with corneal and refractive problems. A full range of anterior segment surgical procedures are offered including all types of cataract and intraocular lens operations. While this service does not offer refractive surgery, we do consult on patients who have had complications related to these procedures.
Oculoplastics, Orbital & Reconstructive Surgery
This service evaluates and manages lid tumors, lid malpositions, lacrimal problems, orbital tumors, orbital inflammatory diseases ,and trauma of the lids, orbits, and lacrimal system. Complex conditions related to thyroid eye diseases and various eyelid and orbital cancers are managed by experts in the field. In addition, cosmetic and reconstructive procedures are performed by specialist in this service.
Neuro-Ophthalmology & Orbit
This service bridges the interface between ophthalmology, neurology, neurosurgery, plastics, and head & neck surgery. Patients with ophthalmic manifestations of systemic disease are often seen through this service. In addition to neuro-ophthalmic problems, this subspecialty service treats orbital and oculo-plastic disorders and serves as the ophthalmic consultation service for a wide variety of unusual pathology.
Current clinical research interests of the Neuro-Ophthalmology division include skull-base tumors, their neuro-ophthalmic manifestations and clinical approaches, pseudotumor cerebri, the optic neuropathy of increased intracranial pressure, and anterior ischemic optic neuropathy (natural history and treatment). Additional research involves the application of automated static perimetry to neuro-ophthalmology, potentials for therapy in various forms of optic neuropathy, orbital and cerebrovascular blood flow and the use of needle aspiration techniques in the diagnosis of tumors of the orbit and skull base. Quantitative techniques are being examined to improve the ability to study natural history and detect progression in various neuro-ophthalmic disease processes. The hospital has a superconducting magnetic coil resonance imagery, which is currently available for clinical research.
The Neuro-Ophthalmology Service at the University of Virginia also sees most of the patients undergoing Gamma Knife therapy. In conjunction with the Neurosurgery Department and the Otolaryngology Department at the University of Virginia, there is also an opportunity of advancing the frontiers in endoscopic skull base surgery.
This service provides care for patients with all kinds of glaucoma, from early to advanced, and performs consultation and management of complex and unusual glaucoma cases.
In addition to the vision and eye pressure, the thickness of the cornea (the clear window of the front of the eye) is measured to determine if the eye pressure may actually be higher or lower than the value measured by the standard applanation technique, which is affected by the corneal thickness. Knowledge of the corneal thickness helps to predict how likely it is for a given patient with a high eye pressure and no optic nerve or visual field damage to go on and develop glaucoma later on if the pressure is not treated. Therefore, not all patients with a high eye pressure may need to be treated, while some with lower eye pressures should be aggressively treated to prevent vision loss years down the road.
The drainage angle of the front of the eye between the cornea and iris (the colored part of the eye with the pupil that lets in light to the back of the eye) is where the clear, watery fluid in the eye drains out. This area is examined with a small, mirrored contact lens by gonioscopy to determine if a patient has an open, narrow or closed angle and whether there is any indication of abnormal blood vessels or prior eye injury to explain the cause of the increased eye pressure. Knowledge of the angle structure can greatly help in the initial diagnosis and appropriate management of each individuals patient's type of glaucoma.
The peripheral visual field (or peripheral vision) is routinely tested with the new and faster method called the Swedish Interactive Threshold Algorithm, or SITA (usually 4-6 minutes per eye instead of 6-12 minutes with the older machines). This newer test can measure the peripheral vision faster and more reliably to aid in the early diagnosis of vision loss from glaucoma and helps to follow glaucoma patients for long-term change. Finding early changes on this visual field test can help the physician intervene sooner to lower eye pressure more aggressively, to prevent long-term vision loss, before the patient is aware of it.
The latest technology for computerized diagnostic imaging of the optic nerve with the Optical Coherence Tomography (also called OCT) or GDx instruments, along with standard computerized, digital photography, is utilized routinely to examine and document the appearance and shape of the optic nerve in the back of the eye. These instruments also measure the nerve fiber layer thickness, which is usually the first part of the eye to be damaged in glaucoma. These instruments can pick up early loss of the microscopic nerve fibers of the optic nerve to help diagnose early glaucoma, before it becomes visually significant, and help the physician decide when to begin early glaucoma treatment or increase therapy for advanced disease.
Up-to-date medical therapy is utilized for early, moderate, and advanced glaucoma. Laser and intraocular surgical procedures for moderate and advanced glaucoma are routinely performed. Patients with cataracts, both with and without glaucoma, are helped with up-to-date cataract surgery. The following procedures are performed:
- Trabeculectomy, or filtering surgery, with the anti-scarring agent Mitomycin C to increase surgical success in advanced glaucoma;
- Baerveldt and Ahmed glaucoma implants in advanced glaucoma;
- Cataract surgery utilizing the latest techniques of a small, temporal clear corneal incision, phacoemulsification, and modern foldable intraocular lenses;
- Combined cataract and glaucoma surgery utilizing all of the above techniques;
- A variety of laser surgical procedures for various types of open angle and angle-closure (also called narrow angle) glaucoma.
This service provides care for patients with medical and surgical problems of the retina and vitreous, including ocular tumors.
We perform a large volume of surgical procedures annually. In addition, we see patients with non-surgical retinal diseases including dystrophies, degenerations, and inflammatory eye disease. Diabetic retinopathy and macular degeneration are areas of particular emphasis in clinical and research projects. The service utilizes up-to-date and cutting edge therapeutic and diagnostic technologies including various lasers, imaging instruments, and surgical techniques including endoscopic surgery.