About Eye and Vision Institute
The Eye and Vision Institute integrates specialized services such as the Eye Center and The LASIK Center.
Eye Center
The Eye Center is the central diagnostic unit of the Eye & Vision Institute. Located on the 2nd floor of the Nursing Tower, it boasts state of the art equipment, follows internationally-accepted protocols, and is manned by some of the best trained staff in the country. When you see a TMC Eye MD, you never need to go to another facility to have further tests done. Regardless of case complexity or subspecialty, the Eye Center is equipped to service your doctor’s diagnostic request.
Fundus Photography
The Eye Center houses some of the most advanced imaging machines available. High-definition, 30-degree views of the retina are taken with the Zeiss Visucam for standard fundus photos (FP), while the Optos California can capture an ultra-wide view of the retina at 200-degrees. For bed-bound and pediatric cases (such as babies with retinopathy of prematurity (ROP)), the Clarity Medical Retcam sits in its own room ready to be wheeled out even for the tiniest of eyes.
Angiography
Angiography means assessing the integrity or activity of a vessel or vascular network by observing the flow of fluid or blood through them. It is used in stroke patients (cerebral angiography), cardiac patients (coronary angiography), and the eye is no exception. As blood with an injected dye flows through the retinal vessels, the Optos California takes consecutive ultra-wide static shots to show the passage of dye over time. Leaks will light up, feeder vessels to tumors can be identified, and all sorts of new information can be obtained. In fact, the Heidelberg Spectralis can take a video of the actual passage of the dye, called a dynamic angiography.
Optical Coherence Tomography
Not to be confused with the more widely-known Computed Tomography (CT) scan, an Optical Coherence Tomography (OCT) does not use radiation to generate cross-sectional images. The Zeiss Cirrus machine uses light and Spectral Domain technology to segment sections of the eye like the macula and optic nerve to check for any abnormalities. Particularly useful in glaucoma, retina, uveitis, and neuro-ophthalmology, an OCT gives more information about the eye that may not be visible clinically. Even deeper layers of the eye such as the choroid can be visualized using Enhanced Depth Imaging (EDI). This is particularly useful in sight-threatening conditions like polypoidal choroidal vasculopathy (PCV).
The Zeiss AngioPlex is also capable of generating an angiography by visualizing the flow of red blood cells in the retinal circulation, even without the injection of a dye, using highly advanced camera software, in a procedure called an OCT-A (optical coherence tomography angiography).
Ultrasound
The Eye Center has two ultrasound machines: one (A-scan) used mostly for obtaining the length of the eye for pre-operative calculations, when the cataract is too thick and dense, while the other (B-scan) for visualizing globe contents, retinal detachment, and lesions within or even behind the eye itself.
Lasers
Not only does the Eye Center house diagnostic instruments, but interventional ones as well. There are numerous applications for lasers in Ophthalmology: Selective Laser Trabeculoplasty and YAG Laser Iridotomy to treat glaucoma, YAG Capsulotomy to remove capsular opacities after cataract surgery, but most notably, focal laser therapy (FLT) and pan-retinal photocoagulation (PRP) in diabetic patients or those with other retinal vascular problems. FLT involves applying laser to specific points or small sections of the retina, while PRP creates thermal burns on the entire periphery. The Eye Center has a PASCAL: Pattern Scanning Laser, a semi-automatic system with the ability to deliver multiple laser shots in a predetermined pattern array in less than 1 second. This makes the laser procedure quicker, safer, and more convenient.
Visual Field Testing / Perimetry
The TMC EVI employs the Zeiss Humphrey Field Analyzer 750im, which is capable of conducting all of the most commonly requested visual field protocols: 30-2, 24-2, 10-2, etc. Any condition that affects the visual field will at some point need a perimetry—whether its glaucoma, or a neuro-ophthalmological disorder, or even a cerebral condition such as a stroke, a VFT is taken to document the defect and monitor.
Optic Nerve / Disc Photo
The Zeiss Visucam at the Eye Center is capable of taking photos of the optic nerve through an undilated pupil as small as 3.3mm. This means that no eye drops need to be instilled into your eye prior to the test, making it quick, convenient, and comfortable. Disc photos are essential in the management and monitoring of glaucoma, but are also important in neuro-ophthalmological diseases such as optic neuritis, or rare optic nerve colobomas.
Specular Microscopy and Pachymetry
Assessment of the corneal structure plays a part in the diagnosis of many eye diseases. To examine endothelial cell number, size, and regularity, as well as corneal pachymetry, the Eye Center uses the Oculus CorVis System. This test is routinely done as part of pre-operative cataract surgery planning, or in the evaluation of corneal endothelial dystrophies.
Anterior Chamber Angle Imaging
This test uses the Wavelight Oculyzer II on Pentacam HR technology to visualize structures from the anterior surface of the cornea, to the back of the lens. This is most commonly requested in cases of angle closure, such as in phacomorphic glaucoma or ciliary body tumors.
The LASIK Center
The Medical City Eye and Vision Institute’s LASIK Center is one of the most advanced centers of its kind in the country. Featuring the most cutting-edge equipment with the industry’s best, internationally-trained specialists, the LASIK Center is ready to meet your laser refractive surgery needs.
LASIK stands for Laser-Assisted In-situ Keratomileusis, a technique that permanently alters the shape of the cornea (the clear covering in the front of your eye) to correct refractive errors—giving you glasses-free vision for many, many years.
Our LASIK Center uses the Wavelight EX500 Excimer Laser, and can correct up to -12.00 diopters of myopia (nearsightedness), up to +6.00 diopters of hyperopia (farsightedness), and up to -6.00 diopters of astigmatism. In instances wherein the patient’s refractive error or “grade” goes beyond the FDA-approved treatable range of the machine, or if screening shows that you are otherwise not an ideal candidate for LASIK, the Center’s service does not stop there. Other options include PRK (photorefractive keratectomy), phakic intraocular lens implantation, or refractive lens exchange. Your doctor will work with you to decide on the best option for your case.
Corneal Topography
At the heart of laser refractive surgery is an understanding of the shape and contour of the cornea, and its effect on your vision. Three dimensional maps must be generated that tell your surgeon how best to correct your refractive error. The LASIK Center uses the Oculyzer Scheimpflung-based topography, and Oculus Keratograph Placido disc topography to do this. Topographic maps are useful in prescribing glasses for patients with irregular astigmatism, indispensable for laser refractive surgery candidates, and essential for corneal transplant patients.
Tear Film Analysis
The LASIK Center contains one of the few comprehensive Dry Eye Clinics in the country. It uses the Oculus Keratograph for tear film screening, and the TearLab Osmometer to give a qualitative and quantitative assessment of your tears down to the molecular level. A high resolution camera takes both white and infrared light photos, and guides observation of Meibomian gland dysfunction, tear film volume, and any tear film instability using Non-Invasive Keratograph Break-Up Time (NIKBUT).
Teleophthalmology is a program where images of the eye from various locations within the TMC network can be sent securely via the internet and be interpreted remotely by specialists while maintaining quality, confidentiality and cost-efficiency of care. This is especially useful in the evaluation and monitoring of diabetic eye disease as it allows for the detection of eyes at risk for visual loss by providing specialized eye services at distant primary care locations. The teleophthalmology program of TMC-EVI is the pioneer in remote retinal image evaluation in the country and has won the Gold Medal in Innovation in Healthcare IT at the 2014 Asia Hospital Management Awards.