Clarus Eye Centre offers a variety of options for surgical correction of vision including CustomVue LASIK, LASIK, PRK and Clear Lens Extraction. All of these procedures are performed right here in Lacey. Dr. Jay Rudd leads our corrective surgery team and is the only fellowship-trained cornea/refractive surgeon in South Puget Sound.

CustomVue LASIK with WaveScan® Technology
The latest advance in LASIK technology adds a new level of precision to LASIK surgery. Every eye is unique. WaveScan technology creates a map of your eye that guides the surgical laser with even greater accuracy. In clinical trials, CustomVue LASIK resulted in 96% of patients achieving 20/20 or better, 70% achieving 20/16 or better and 23% achieving 20/12 or better.

Laser Assisted In-Situ Keratomileusis (LASIK)
LASIK is the most popular refractive surgery procedure performed today for the correction of nearsightedness, farsightedness and astigmatism. In less than five minutes, we can reshape your cornea with a precision laser to produce excellent vision without glasses or contacts. At Clarus, we use the Visx Star S4 Active Trak laser system.  It features state of the art eye tracking technology and creates a new level of surgical precision to correct your vision.  A protective flap of cornea is created with a microkeratome. The flap is gently folded back and the cornea is reshaped with a cool beam of laser.  The flap is repositioned and seals without sutures.  LASIK allows for quick visual recovery with very little discomfort.  Post-operative drops are used for one week and artificial tears are used more frequently for the first few months. 

Photo-Refractive Keratectomy (PRK)
PRK was the first procedure to utilize the precision of the excimer laser to reshape the cornea. PRK is designed to correct nearsightedness, farsightedness and astigmatism.  PRK is recommended if your cornea is too thin for the LASIK procedure.  PRK is similar to LASIK as both use the VISX Laser, but there is no flap created.  Instead the laser is applied to the outer corneal tissue resulting in a longer visual recovery, more discomfort, and several months of post-operative drops. 

Clear Lens Extraction (CLE)
CLE is the best alternative for farsightedness and presbyopia (need for reading glasses). A small incision is made, the existing human lens is removed with ultrasound, and is replaced with a bifocal style intraocular lens implant.  CLE can achieve clearer distance and reading vision without glasses and eliminates the need for cataract surgery in the future.  It allows for a fairly quick recovery, and the post-operative drops are tapered over three weeks. 

Astigmatic Keratotomy (AK)
AK corrects astigmatism only. A diamond-blade is used to create one or two tiny incisions that are strategically placed in the cornea to reduce your amount of astigmatism.  AK results in very quick visual recovery with little or no discomfort. post-operative drops are used for one week. 

CATARACTS

A cataract is the clouding of the eye’s natural lens. In normal vision, light enters the eye, passing through the lens, and is focused on the retina in the back of the eye. When the lens is cloudy, light is blocked, and the image that reaches the retina is out of focus, causing blurred or distorted vision. Glare, dull colors and blurred vision are common complaints from people with cataracts. Cataracts are the leading cause of visual loss among adults 55 and older. Although the aging process is the most common cause of cataracts, they can also result from disease or injury. Cataract surgery should be considered when cataracts cause enough loss of vision to interfere with daily activities.

In a ten-minute surgical procedure, the cloudy lens is removed through a micro-incision (less than 1/8") with an ultrasound, a process known as phacoemulsification. The incision is self-sealing, so in most cases “stitches” are not necessary. After the cloudy lens is removed, an intraocular lens is inserted to replace the eye’s focusing ability, resulting in clearer vision.

At Clarus, we offer the latest advances in intraocular lens technology. Currently, patients have the following options:

• Monofocal lens
• “Array” bifocal lens
• Astigmatism lens
• Tecnis lens
• Alcon “Natural” lens

We utilize the most sophisticated technology for the measurement of the implantable lenses. Careful selection of the appropriate implant is critical. Your doctor has experience with the many different options available and will help choose the intraocular lens that will benefit your specific needs.

GENERAL EYE CARE & CONTACT LENSES

General Eye Care
Clarus Eye Centre has been delivering clear vision to families since 1968. Fellowship-trained ophthalmologists, optometrists and a caring, professional staff work together to help you maintain healthy eyes and clear vision into the future. Your vision should be checked routinely at least every two years. A regular, professional eye examination can detect serious eye disease in the early, treatable stages. It includes:

A complete history of your current eye symptoms, as well as your general health.
A measurement of your vision, and determination of the power for your current glasses.
An eye pressure test for glaucoma.
Dilation of your pupils that allows a comprehensive medical exam of the back of your eye.

Contact Lenses
Dr. Chad Waggoner is our contact lens and eye-glass professional at Clarus Eye Centre. In consultation with Dr. Waggoner, you have many options available to you.

• Soft contact lenses for almost any prescription, including high astigmatism
• Rigid gas permeable
• Bifocal soft and rigid gas permeable
• Tinted contact lenses for enhancing or changing the color of your eyes
• Therapeutic lenses for eye disorders

To be fit for contacts, you will need an evaluation by our contact lens specialist, Dr. Chad Waggoner. He will discuss your expectations and the type of contacts that are available to you.

You will receive instructions on how to wear your contacts and properly care for them to ensure the safety of your eyes. You will be asked to return at regular intervals to check your eyes for changes brought on by contact lens wear.

CORNEAL & EXTERNAL DISEASE

Cornea Transplant (Penetrating Keratoplasty)

The cornea is the eye’s outermost layer. It is the clear, dome-shaped surface that covers the front of the eye. The cornea helps focus light as it passes through the eye. An unhealthy cornea can distort and cloud vision. Permanent damage to the cornea may require a corneal transplant.

What is a corneal transplant? Is it safe? A corneal transplant involves replacing a diseased or scarred cornea with a new one. When the cornea becomes cloudy, light cannot enter the eye to reach the light-sensitive retina. Poor vision or blindness may result.

The first step in a corneal transplant is to find a donor cornea. Currently there is no wait for a donor cornea in the state of Washington through the Northwest Lions Eye Bank. The donated cornea is thoroughly tested for infectious disease, and for its suitability for transplantation.

In corneal transplant surgery, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear cornea. A trephine, an instrument like a cookie cutter, is used to remove the cloudy cornea. The surgeon places the new cornea in the opening and sews it with a very fine suture. The suture stays in for months or even years until the eye heals properly (removing the suture is quite simple and can easily be done in our office). Following surgery, eye drops to help promote healing will be needed for several months. Most patients return home the same day of surgery. A friend or family member will need to drive you home after the procedure.
Corneal transplants are very common in the United States; about 40,000 are performed each year. The chances of success have risen dramatically because of technological advances, such as less irritating sutures or threads, which are often finer than a human hair; and the surgical microscope. Corneal transplantation has restored sight to many who, a generation ago, would have been blinded permanently by corneal injury, infection, or inherited corneal disease or degeneration.

What problems can develop from a cornea transplant?
Even with a fairly high success rate, problems can develop, such as rejection of the new cornea, corneal swelling, and infection. Warning signs of a problem are decreased vision, increased redness of the eye, increased pain, and increased sensitivity to light. If any of these last for more than six hours, you should immediately call your ophthalmologist. Most complications can be successfully treated if medication is administered at the early sign of symptoms.

Are there alternatives to a corneal transplant?
Phototherapeutic keratectomy (PTK) is one of the latest advances in eye care for the treatment of corneal dystrophies, corneal scars, and certain corneal infections. Only a short time ago, people with these disorders would most likely have needed a corneal transplant. By combining the precision of the excimer laser with the control of a computer, doctors can vaporize microscopically thin layers of diseased corneal tissue and etch away the surface irregularities associated with many corneal dystrophies and scars. Surrounding areas suffer relatively little trauma. New tissue can then grow over the now-smooth surface. Recovery from the procedure takes a matter of days, rather than months as with a transplant. The return of vision can occur rapidly, especially if the cause of the problem is confined to the top layer of the cornea. Studies have shown close to an 85 percent success rate in corneal repair using PTK for well-selected patients.

EXTERNAL DISEASE

Conjunctivitis
Conjunctivitis is the term used to describe inflammation of the conjunctiva. Many refer to it as “pink” eye. A thin, membrane called the conjunctiva covers the white part of the eye. The conjunctiva has fine blood vessels, but when it becomes irritated or inflamed, the blood vessels enlarge and become more prominent and the eye turns red.

There are many different sources of eye irritation that can cause conjunctivitis.
The most common are:

• infections
• allergies
• environmental irritants

Infectious conjunctivitis can be caused by a bacteria or virus. Bacterial infections, such as staphylococcus or streptococcus, cause a red eye that is associated with considerable amounts of discharge. Some bacterial infections are more chronic and may produce little or no discharge, except for mild crusting of the eyelashes in the morning.

Viruses are also common causes of conjunctivitis. Some viruses produce the familiar red eyes, sore throat, and runny nose of a common cold. Others may infect only one eye. Viral conjunctivitis usually produces a watery discharge and lasts from one to two weeks.

Infectious conjunctivitis, whether bacterial or viral, can be very contagious. Frequent hand washing is recommended to help to prevent spread of the infection.

Some allergies, like hay fever, may produce a chronic redness and itching. Any type of conjunctivitis is aggravated by dryness of the eyes or environmental irritants, such as smoke.

Other Causes of Red Eyes
A red eye can occur with other eye diseases that can lead to blindness unless recognized and treated. An evaluation by an eye physician is important to avoid confusing them with conjunctivitis. This is especially important if pain, blurred vision, or severe light sensitivity is present, since these symptoms are not typically found in simple conjunctivitis.

Contact us if symptoms worsen or persist.

Pterygium
A pterygium is a triangular-shaped tissue growth on the cornea. Some pterygia grow slowly throughout a person's life, while others stop growing after a certain point. A pterygium rarely grows so large that it begins to cover the pupil of the eye.

A pterygium usually has no symptoms, and many do not require treatment. However, some pterygia become red and inflamed from time to time. A large or thick pterygium may be more irritating than painful. Occasionally, a large pterygium will begin to change the shape of the cornea and cause vision changes (astigmatism).

Although it is uncertain what causes pterygia, many doctors believe ultraviolet (UV) light from the sun may be a factor. Wearing protective eyeglasses, sunglasses, and/or hats with brims is suggested in sunny climates.

If a pterygium becomes red and swollen or chronically irritated, it can be surgically removed. Lubricants can also help reduce the redness and provide relief from the irritation.

Blepharitis
Blepharitis is a chronic inflammation of the eyelids and is one of the most common disorders of the eye. Oils and other secretions build up on the eyelid surface and eyelashes, resulting in red, flaking or crusting of the eyelids. Other symptoms can include a sandy, gritty sensation, with burning, itching and/or redness. Although blepharitis is a chronic problem, applying warm compresses and lid scrubs can help control it. In some cases, it may be necessary to prescribe an antibiotic ointment.

• Warm compresses – soak a clean washcloth in very warm water, squeeze out the excess water, and then press it against your closed eyelids for approximately five minutes. You may need to rewarm the cloth several times. This will help to soften and loosen the debris on the eyelids.


• Lid scrubs – following the warm compresses, pull your eyelid away from your eye and gently clean the eyelid margin (at the base of your lashes) with the edge of the washcloth using a side-to-side motion. You may use solution with a small amount of baby shampoo mixed with an equal amount of water to cleanse your eyelids or a pre-packaged eyelid scrub solution.

The above treatment should be repeated two to four times daily for the first two or three weeks. As your symptoms improve, you can decrease the frequency as necessary to maintain your comfort level. Remember this is a chronic condition and stopping treatment altogether may result in a recurrence of symptoms.

GLAUCOMA

Glaucoma is a degeneration of the optic nerve, which is the main nerve that connects the eye to the brain. The degeneration is related to the pressure in the eye, which may be elevated. The eye constantly produces aqueous, the clear fluid that fills the anterior or front chamber of the eye. The aqueous flows out of the anterior chamber through a complex drainage system. The delicate balance between the production and drainage of aqueous determines the eye’s intraocular pressure. In patients with glaucoma, the outflow of fluid may become restricted, causing the pressure inside the eye to rise. However, some forms of glaucoma have no pressure elevation. If left untreated, glaucoma can damage the optic nerve. Damage to the optic nerve is permanent and will lead to blindness. Lowering eye pressure is the only known effective treatment.

Medical Treatments
Prescribing eye drops is usually the first step in lowering the eye pressure. Some medications reduce the eye pressure by decreasing the production of aqueous. However, because the aqueous supplies nourishment to the front of the eye, the body has a built-in mechanism that limits the extent the eye’s pressure can be lowered with medication. Other medications work by improving the outflow of fluid from the eye. For the maximum benefit, these two types of drugs are often used together. When medications no longer control the eye pressure adequately or cannot be tolerated, surgery may be needed.

Argon Laser Trabeculoplasty (ALT)
ALT is a surgical approach that uses laser to lower eye pressure by increasing the outflow of aqueous. Alt has been performed since the early 1980’s on millions of patients. This relatively painless procedure is performed in the office and requires no surgical incision. There is no risk of infection. This procedure takes 15-20 minutes and does not permanently affect vision. The full effect of ALT takes approximately 3-4 weeks. Recent long-term studies have shown initial success rates to be 75-85% at one year, 50% at 5 years, and 32% at ten years; therefore there is some loss of effect after many years. Residual scarring after this procedure is very rare, with the newer techniques utilized at Clarus. Some types of glaucoma respond to ALT better than others. This may be repeated if necessary. Selective laser trabeculoplasty (SLT) is a similar laser procedure used to lower eye pressure. Current studies indicate success rates comparable to ALT. If laser treatment is not successful, other surgical or medical therapies remain available.

Visocanalostomy
Recent advancements in surgical technique have led to the development of a procedure called viscocanalostomy. This surgery involves accessing an internal canal and injecting a thick visco-elastic fluid in the eye to expand the drainage canal.

This technique allows the aqueous fluid to flow from the front of the eye at a much more controlled rate than with other glaucoma surgeries. Because of this, the eye pressure is much more likely to fall in the desired range after the operation, significantly reducing the risk of an extremely low pressure (hypotony). Another advantage of viscocanalostomy is that it stimulates the body’s healing mechanism less than trabeculectomy, so there is a reduced tendency for scar tissue to form and the eye pressure to rise.

Although viscocanalostomy takes longer for the doctor to perform and requires more skill, it is much simpler for the patient. This procedure can be performed alone or along with cataract surgery. Most patients enjoy a quick recovery following viscocanalostomy compared to other glaucoma surgeries, along with less dependence on medication, fewer postoperative visits, and reduced risk.

Trabeculectomy
A trabeculectomy involves surgically creating a reservoir (bleb) on the top of the eye, usually under the upper eyelid. Aqueous fluid from inside the eye flows into the bleb and then is absorbed. The new drain is entirely inside the eye. The fluid does not enter your tears or flow down your cheek; it is reabsorbed into your blood stream. Although this cannot reverse existing damage from glaucoma, a trabeculectomy may stop progression. Recent advances include the use of 5FU (5 Fluorouracil) or Mitomycin. These drugs are two very powerful “anti-scarring” agents that help the flow at the surgery site. These are either used during or after surgery. Laser treatment and frequent drops may also be used.

After surgery, the vision in your operative eye will be decreased for approximately 4-6 weeks. You will need to use multiple drops at frequent intervals after the surgery. You will also need multiple appointments each week after surgery for approximately 4-6 weeks. The drop frequency and appointment frequency will be determined on an individual basis as you continue to heal after the surgery. In some cases, additional procedures may be necessary to adjust the pressure.

Other Glaucoma Surgeries
If conventional glaucoma surgeries are not successful, or would have a poor chance of success, then more advanced surgeries are available at Clarus. Glaucoma tubes (“shunts”) can be inserted in the eye to improve fluid outflow. Another option is the fluid producing tissue in the eye (“ciliary body”) can be damaged to reduce fluid flow with a laser. These procedures require specialized skills to perform, carry additional risks, and are offered in complex cases, if the need arises.

RETINAL DISEASE, DIABETES & MACULAR DEGENERATION

Retinal Conditions Treated at Clarus:

• Diabetic Retinopathy
• Retinal Tears and Detachments
• Epiretinal membrane
• Macular Hole
• Age-related macular degeneration

Diabetic Retinopathy
At Clarus we provide comprehensive evaluation and treatment for diabetic retinopathy. All our physicians are qualified to detect signs of diabetic retinopathy.

Dr. Anthony Truxal is a board certified, fellowship-trained retinal specialist. He performs laser treatment and surgery (when necessary) to treat diabetic retinopathy. The treatments performed are:

• Laser Focal Photocoagulation
This is a procedure performed in our office to treat non-proliferative diabetic retinopathy. The treatment usually takes less than 10 minutes to perform. The purpose is to reduce the swelling of the retina and improve the chance of retaining vision.
• Argon Laser Pan-retinal Photocoagulation
This is procedure is usually performed at the St. Peter Hospital outpatient surgery center. The goal is to cause regression of abnormal blood vessels and to prevent further formation of abnormal blood vessels in patients with proliferative diabetic retinopathy.

Retinal Tears and Detachments
The physicians at Clarus are trained to detect detachments and tears in the retina, the lining of the eye. Dr. Truxal is specially trained and has years of experience in the treatment and repair of these conditions.

Retinal tears are breaks in the lining of the eye. They often require treatment with a laser to seal the edges of the tear to prevent fluid from seeping under the retina and causing a retinal detachment. Laser treatment for this condition is usually performed at the St. Peter Hospital outpatient surgery center.

Retinal detachment is a separation of the lining of the eye that usually follows an untreated retinal tear. The procedures and surgeries required to repair a retinal detachment depend on the type and severity of detachment.

More information on retinal detachment can be found at the National Eye Institute website.

Macular Hole
A macular hole is a break in the part of the retina responsible for sharp, fine central vision. They are more common in people over 60 years old. They do not lead to retinal detachment, however they can impair the ability to see clearly to read, drive or do other activities that require clear vision.

Dr. Truxal performs the surgery to correct macular holes, called a vitrectomy. In a vitrectomy for macular hole, the gel like fluid in the eye is removed and is replaced with at special gas to act like a bandage on the hole until it is sealed.

Epiretinal Membrane
An epiretinal membrane is scar tissue that forms on the macula, the part of the retina responsible for sharp, clear central vision. The same condition that causes a macular hole can cause an epiretinal membrane.

Epiretinal membrane can cause blurred, distorted vision. Usually it is mild and does not require treatment. When the vision is more severely affected Dr.Truxal can perform a procedure called a vitrectomy to remove the scar tissue from the macula.

Age-related Macular Degeneration
There are two types of macular degeneration (AMD), wet and dry. The dry form is more common, affecting approximately 90 percent of patients with the condition. There is no treatment available for dry AMD. Wet AMD affects only 10 percent of patients with the condition, but it is responsible for 90 percent of the vision loss associated with AMD.

Wet AMD can sometimes be treated with lasers. There are two types of laser treatment currently performed at Clarus, thermal and non thermal. The non-thermal is called photodynamic therapy (PDT).

All the physicians at Clarus are qualified to diagnose macular degeneration. Dr. Truxal evaluates and in many cases treats patients diagnosed with wet AMD.

EYELID & FACIAL PLASTIC SURGERY

Blepharoplasty – Upper and/or Lower Eyelids
Are you tired of always looking tired? The loose skin over your eyes and the fat bags under your eyes can make you look more tired and older than you really feel. As you age, your eyelid skin can stretch, your muscles weaken and the fat accumulates around your eyes. Blepharoplasty (eyelid surgery) helps eliminate droopy eyelid skin, making you look younger and more alert.

Blepharoplasty can be performed using a local anesthetic. We place fine incisions in the crease of the upper eyelids and remove the excess skin and fat. A laser is often used to speed the recovery. To eliminate the lower lid bags, the surgery is performed through the inside of the lower eyelid to hide the incisions. The procedure, depending on the complexity, usually takes about 15-30 minutes.

Your medical insurance may cover an upper eyelid blepharoplasty. We would need to perform a special test to determine if you meet your insurance criteria.

Endoscopic Browlift
Lines in your forehead can be caused by aging, laughing, crying or even sleeping. This can be corrected with a forehead and brow lift. People with sagging eyebrows may choose this surgery to eliminate their sad or angry look. By elevating the brow, the tired and unhappy look may disappear completely.

Dr. David Pratt performs an Endoscopic Brow Lift using a small fiber optic camera inserted through tiny incisions placed in the hairline. This allows visualization of the surgery on a television monitor and reduces the incision size, minimizing scarring and allowing for a quicker recovery. He is the only surgeon in Thurston County routinely performing this state-of-the-art surgery.

Tear Duct Surgery
If you are experiencing excessive tearing you may have a tear duct obstruction. Tears normally drain into the puncta (small holes located on the inside corners of the upper and lower eyelids). Tears collect in the tear sac that lies under the skin between the corner of the eye and the nose. The tears then flow through a small tube, called the nasolacrimal duct, into the nose. The tears are pumped through this drainage system by the blinking of the eye.

A blockage anywhere in the drainage system can prevent proper drainage of tears and lead to excess tearing. If it is determined there is a blockage in your tear system, it may be necessary to perform a Dacryocystorhinostomy (DCR). A small incision is placed on the side of the nose. A small hole is then created in the paper-thin bone where a small, temporary tube is placed from the inside corner of the eye into the nose. The tube is used as a stent in the tear drainage system to prevent scarring. The tube is easily removed in the office approximately 3 months post-operatively.

Thyroid Eye Disease / Proptosis
Grave’s Disease is an autoimmune condition where the immune system mistakenly attacks the thyroid gland, causing the patients to develop proptosis or bulging eyes. The space between the lids may widen producing a staring appearance. Because the eye muscles are involved, some patients may develop double vision. In the worst cases, vision may be threatened due to compression of the optic nerve. In those cases, a procedure called an orbital decompression may be required.

Oribital Repair
Following an ocular trauma, the orbital structure (the boney structure that surrounds the eye) may be fractured or compromised. Dr. Pratt performs facial and/or orbital reconstructive surgery to repair the affected structure.

Botox
Botox® is a treatment used to reduce blepharospasms, eyelid twitching, and/or hemi-facial spasms. Botox is delivered by strategically placed injections in the affected muscles. Botox is a toxin produced by the same bacteria responsible for botulism. However, when very small amounts of the toxin are injected into the eyelid muscles it is proven to be safe and effective. The effectiveness is temporary; therefore periodic injections may be necessary.