Oculoplastic surgery largely consists of traditional approaches to many of the encountered diseases.  Our specialty has well-established methods for most surgeries and we use our good old fashioned surgical instruments, but advances are continuously being made to improve patient outcomes while at the same time abiding by sound surgical and medical principles according to anatomy.  These advances are made in both surgical and non-surgical approaches to functional and aesthetic oculoplastic surgery. There has been a lot of excitement in ocuplastic surgery recently. New surgical techniques, many of which are less invasive, new cosmetic tools with particular utility around the eyes, and new team approaches have fueled the excitement. The aging baby boomer population has increased demand for cosmetic procedures; the ability to work outside the traditional insurance system has added momentum to the interest and curiosity of ophthalmologists. Indeed the accreditation given to American Society of Ophthalmic Plastic and Reconstructive Surgery by the Accreditation Council for Graduate Medical Education will ignite the debate over sub-specialty board certification for ophthalmic plastic surgery.

Pediatric ophthalmology is a sub-speciality of ophthalmology concerned with eye diseases, visual development, and vision care in children. The pediatric ophthalmologist has additional training, experience, and expertise in examining children, and has the greatest knowledge of possible conditions that affect the pediatric patient and his/her eyes.  Neurologic development of vision occurs up until approximately age 12 years. Misalignment of the eyes (strabismus), uncorrected refractive error (myopia, hyperopia, and astigmatism), and asymmetry of refractive error between the two eyes can negatively affect this development.  If these conditions are diagnosed and treated early, good vision can develop and can be maintained.  Certain diseases elsewhere in the body, such as diabetes, can affect the eyes, and the pediatric ophthalmologist addresses these, as well.

Right when the eyes lenses get the opportunity to be shady, Cataract evacuation is for the most part supported and in this way Cataract surgery like Cryoextraction is performed. In Cataract surgery, the lens inside the eye that has wound up shady is removed and supplanted with a mimicked lens (called an intraocular lens, or IOL) to restore clear vision. The system routinely is performed on an outpatient start and does not require an overnight stay in a center or other thought office. Most present Cataract surgery integrates the usage of a high-repeat ultrasound device that segregates the cloudy lens into minute pieces, which are then carefully removed from the eye with suction. The up and coming Refractive Surgery Conference may likewise concentrate on Cataract surgery as this is the most broadly recognized eye sickness everywhere throughout the world.

If you have a refractive error, such as farsightedness (hyperopia), astigmatism or presbyopia, refractive surgery is a method for amending or improving your vision. There are various surgical procedures for correcting or adjusting your eye's directing ability by reshaping the cornea, or clear, round dome at the front of your eye. Other procedures involve inserting a lens inside your eye. The most widely performed type of refractive surgery is LASIK (laser-assisted in situ keratomileusis), where a laser is used to reshape the cornea.

The retina is a thin layer of tissue on the inside back wall of your eye. It contains millions of light-sensitive cells and other nerve cells that receive and organize visual information. Your retina sends this information to your brain through your optic nerve, enabling you to see. Retinal degenerative disorders such as Age-related macular degeneration and Myopic macular degeneration affecting young and old from many cultures, races and ethnicities. The central area of the retina contains a high density of color-sensitive photoreceptor cells called cones which are responsible for color vision and hence any defect and alteration in the central area of the retina will lead to Color vision defects. On the other hand diseases like Diabetic retinopathy and Retinal tumors can also be responsible for the permanent vision loss if it is not treated on time. Historically, retinal disease has had a low priority in prevention of blindness programs in developing countries. There are several reasons for this. Firstly, it was thought that retinal disease was an uncommon cause of blindness in the developing world; secondly, that the results of treating retinal disease did not justify the effort and expense involved; and, thirdly, that the equipment required was too costly and unreliable for use in a developing country environment. Finally, there is a lack of skilled personnel with sub-specialty training in retinal disease. John Hopkins School of Medicine, UCSF School of Medicine, David Geffen School of Medicine and Mayo Medical School are the leading institutes associates with ophthalmology.

Glaucoma is a multifactorial optic neuropathy that affects more than 50 million people and is the second leading cause of blindness worldwide. The role of intra ocular pressure (IOP) has been well documented as a major modifiable risk factor for glaucoma. Additionally, many glaucoma patients have a relatively low IOP, while some healthy individuals have a relatively high IOP. The disorders can be roughly divided into two main categories, open-angle glaucoma and closed-angle glaucoma. Impaired ocular blood flow regulation in open angle glaucoma as a risk of glaucoma has also been well established, especially over the past two decades. Pathophysiology of glaucoma indicates towards the increased in intraocular pressure which compresses and damages the optic nerve. Once the optic nerve is damaged, it fails to carry visual information to the brain and this result in loss of vision. The exact pathophysiology of glaucoma contributing to this is yet to be determined. Biomarkers for glaucoma have predictive use that could help and guide more specific therapy in some glaucoma patients. Endothelin in glaucoma treatment play a very key role in pathogenesis of glaucoma. Glaucoma accounts for over 10 million visits to physicians each year. In terms of Social Security benefits, lost income tax revenues, and health care expenditures, the cost to the U.S. government is estimated to be over $1.5 billion annually. The Glaucoma Research Society of Canada is the only Canadian non-profit organization solely dedicated to funding glaucoma research. Since 1989, it has raised more than two million dollars in support of 150 research projects. The Society funds 10 to 15% of all independent glaucoma research in Canada. Bascom Palmer and Wills Eye are the top researcher organization for glaucoma.

Neuro ophthalmology is the speciality that deals with ophthalmic diseases with neurological problems and various optic nerve disorders. We use almost half of the brain for vision-related activities, including sight and moving the eyes. Neuro-ophthalmology, a subspecialty of both neurology and ophthalmology, requires specialized training and expertise in problems of the eye, brain, nerves and muscles.

Strabismus is a vision problem in which both eyes do not look at the same point at the same time. Strabismus most often begins in early childhood. It is sometimes called crossed-eyes, walleye or squint. Strabismus can be treated surgically or non-surgically. This condition is ideally treated as early as possible (particularly in children) so that it does not progress to require extensive corrections. There are a number of non-surgical treatments for strabismus, all of which put the weaker eye to use in order to strengthen it.

 External eye disease encompasses a very diverse range of conditions. At one end of the spectrum, it includes conditions which form the “bread and butter” of general or primary care ophthalmology, whilst at the opposite end of the spectrum it includes some conditions which may require very complex surgical or systemic treatment.

Ophthalmic pathology focuses on diseases of the eye and its neighboring tissues. Precision diagnosis of diseases is provided by the ophthalmic pathology service. Diseased tissues are examined macroscopically, microscopically and on the ultrastructural level. Advanced genomic, proteomic, and cytogenetic techniques can be utilized to diagnose diseases at a molecular level. The pathologic diagnosis of the disease plays a vital role in patient care. Ophthalmic pathology is a laboratory-based discipline which provides an essential service to ophthalmologists and related professionals by examining samples taken from patients in order to provide a diagnostic opinion. 

Ophthalmic Pharmacology is the study and utilization of medications to both analyze and treat ailments of the eye. There are different microbial maladies of the eye like Fungal contaminations of the cornea, which are uncommon yet may happen after agrarian wounds or in hot and moist atmospheres, orbital mycosis is even rarer, and for the most part happens after spread from the paranasal sinuses. Expanding age, debility, or immunosuppression improves probability and seriousness of illness. 

Ophthalmic Oncology is a highly specialized and niche facility offering expert care in the treatment various cancerous tumours of the eye and surrounding structures. The commonest tumour of the eye occurs in children and is called ‘Retinoblastoma’. The second most common intra-ocular tumour treated is Choroidal Melanoma which largely occurs among adults; it has advance facilities and expertise in procedures such as Transpupillary Thermo Therapy, Brachytherapy, Local Tumour Resection in the form of Eye Wall Resection for effectively treating this condition.

Translational Ophthalmology is a latest trend that bridges the gap by achieving breakthrough discoveries to patients faster than ever. Translational Research is a new initiative of the National Institutes of Health (NIH) which aims to translate basic research into more advanced form to yield the better results. The research trend discoveries maximize the opportunities to investigate the issues very minutely to decrease the risk of failure especially during surgical procedure like cataract and refractive surgery. Many fruitful facts have been discovered which indirectly helps in treating the respective conditions such as Age-Related Eye Disease Study (AREDS) proved that nutritional supplements (nutrition and ophthalmology) could minimize the risk of AMD. The American Health Assistance Foundation, dedicated to eradicating age-related degenerative diseases, estimates that up to 11 million people in the United States have some form of AMD - a number expected to double by 2050. Estimates of the global cost of visual impairment AMD causes are $343 billion, including $255 billion in direct health care costs, according to the foundation. Ophthalmology represents 18 percent of the average case volume in surgery centers, second behind GI/endoscopy (25 percent). The average surgery center performs 4,869 cases annually, which would average to around 876 ophthalmology cases annually, according to VMG Health's 2009 Intellimarker.

Optometry is a social insurance calling that practices on the eyes and related structures, and vision, visual frameworks, and vision data handling in people. Optometrists (otherwise called Doctors of Optometry or Ophthalmic Opticians relying upon the nation) are prepared to endorse and fit focal points to enhance vision, and in a few nations are prepared to analyse and treat different eye sicknesses. Optometric doctors and optometry-related associations communicate with legislative offices, other social insurance experts, and the group to convey eye-and vision-care.

The orbit (eye socket) is the cone-shaped bony cavity in which the eyes are situated. It is padded with fatty tissue and contains eye muscles, nerves, glands and cavities, all of which play important roles in eye function and health. The eye socket can be affected by a range of orbital disorders, including inflammation, tumors, systemic diseases, congenital disorders and physical injuries.

Types of Orbital Disorders

• Orbital fractures are cracks or breaks in the facial bones surrounding the eye. Certain fractures of the orbital bone beneath the eye known as blowout fractures can lead to a range of complications and vision impairment. Severe orbital fractures may require surgical intervention, which involves reconstruction of the orbit.
• Orbital tumors are abnormal growths that vary in size and severity and can be either benign or malignant. The most common symptoms of orbital tumors include inflammation, double vision, discomfort and bulging of the eyeball. At Delray Eye Associates, P.A., we offer specialized treatment for orbital tumors, including orbital surgery and referrals for adjuvant therapy.
• Thyroid eye disease, also known as Graves’ disease, is the most common orbital disorder. It is an autoimmune condition that occurs as a result of impaired function of the thyroid gland. The disease may vary in severity and last several months or years. The most common side effects of thyroid eye disease are eyelid retraction, double vision and protrusion of one or both eyes. Treatments for thyroid eye disease include lubricating eye drops, medication to reduce the orbital inflammation, prisms, and eye muscle and eyelid surgery. In extreme cases, a procedure known as orbital decompression may be performed to reduce bulging eyeballs.
• Anophthalmos (loss of one or both eyes) can be caused by a variety of factors, including traumatic injury and eye cancer. It is also associated with a congenital disorder in which the orbital tissue development has been impaired, leading to the complete absence of an eye. Individuals who suffer from anophthalmos are often faced with a range of problems, including blindness and physical disfigurement of the eye and eyelids. Dr. Kronish specializes in surgery involving reconstruction of the eye socket and prostheses to restore a more natural appearance.

Imaging of the eye is critical to improving the diagnosis, assessment of severity and progression, and evaluation of management of eye disease. Advances have been rapid, with improvements in hardware (such as light sources and imaging chips), optics (such as adaptive aberration compensation) and software (such as image tracking). Imaging of the eye allows changes in its anatomy and physiology to be observed and assessed. Although great advances have been made in imaging chip technology (which has enhanced slit-lamp and fundus photography), imaging of the eye can also be achieved using reconstructed images.

Advances in ophthalmic drug delivery systems such as Punctal Plugs, Ocular Therapeutix, Mati therapeutics (QLT) and gel-forming drops can be breakthrough in ophthalmic research and advance drug delivery system to maximize the therapeutic effect of a particular drug. Topical combination of corticosteroid & anti-infective agents, Drugs used in the treatment of allergic conjunctivitis, Oral & topical nonsteroidal anti-inflammatory agents (NSAIDs) and Retinoblastoma chemotherapy are few developed formulation to treat ophthalmic diseases. Companies like Allergan, Pfizer, Bausch + Lomb, Merck & Co. and Regeneron are actively participated in ophthalmic research and drug development. According to visiongain (Ophthalmic Drugs: World Market Prospects - 2013-2023; October 2013), the worldwide ophthalmic market was $17.5 billion in 2011 and is expected to grow to $34.7 billion by 2023, representing a 5.9% compounded annual growth rate.

It will probably be a number of years before macular degeneration falls into the category of a truly preventable disease. Many individuals with macular degeneration currently reach the point where no surgery, treatment or medication can reverse or halt the devastating progression of this disease. The purpose of the Vision Rehabilitation service is to help these individuals make the most of their limited vision. To accomplish this, state-of-the-art devices will be employed to improve the quality of life of individuals who have experience a loss of vision.

Visual loss often causes depression in individuals with macular degeneration. This response lessens the individual's ability to make adaptations for their vision loss. While many vision rehabilitation programs simply provide a few vision aids, without significant counseling or other instruction, the Vision Rehabilitation unit of the University of Iowa Center for Macular Degeneration employs and incorporates both psychological and physical rehabilitation in its care of individuals with visual impairments.

Individuals with visual impairments are taught to use their remaining visual abilities, much like physical or occupational therapists would help an individual who has suffered from a stroke. By adapting appliances and utilizing vision rehabilitation devices specifically designed for the needs of the individual, many individuals with visual impairments are able to maintain their independence. Another significant advancement has been the development of techniques for individuals to read using only their peripheral vision.