EXPERT
Edwin Schottenstein, M.D., F.A.C.S.
Ophthalmologist
For over 35 years, Dr. Schottenstein has provided compassionate and thorough care for his patients. His attention to detail and willingness to spend the extra time with patients to resolve their needs is the guiding principle of his entire staff and truly sets his practice apart from others.
- New York, NY
- Leland Stanford Jr. University
- Accepting new patients
Femtosecond Laser-Assisted Cataract Surgery
Femtosecond Laser-Assisted Cataract Surgery, or FLACS, replaces many of the steps during cataract surgery that requires a blade and softens the cataract, reducing effective phaco...
Durysta Glaucoma Treatment
What Is Durysta? At the office of Dr. Edwin M. Schottenstein, our mission is to help our patients maintain healthy vision over a lifetime. We hope to provide the highest quality...
Eye Care During COVID-19
At the office of Dr. Edwin M. Schottenstein, we believe that everyone deserves a healthy, clear vision, and our mission is to help our patients maintain healthy vision over a...
LipiFlow
At the office of Dr. Edwin M. Schottenstein, we believe everyone deserves a healthy, clear vision, and our mission is to help our patients maintain healthy vision over a lifetime....
Eye swollen?
What Happens
These Meibomian glands, named after the German doctor who studied them, make an oil called meibum. There are approximately 31 Meibomian glands in your upper eyelid and about 26 glands in the lower eyelid. The glands in the upper eyelid are longer and produce more oil, or meibum, than the ones in the lower eyelid.
There are three layers to your tear film. The oily outermost layer, produced by special glands (Meibomian glands) within the eyelid, serves to prevent evaporation of the saltwater middle layer of the tears and perform barrier functions. The inner layer against the eyeball is made of mucus secreted from cells on the front surface of the eye and is important in helping the saltwater layer spread evenly across the surface of the eye. As you can see, any dysfunction in the layers of the tears can be problematic, and we especially see this with an increase in evaporation from MGD. Each gland contains little pockets called acini that act like an oil factory, producing the meibum. Meibum, water, and mucus form the three layers of tear film, the fluid that keeps your eyes moist. As previously mentioned, the oil helps prevent the water layer on the eye surface from evaporating or drying out too quickly. Changes to the amount or quality of the oil, or to the glands themselves, can lead to MGD. It's often the result of a combination of things. The most common type, obstructive MGD, happens when the gland openings get clogged, and less and less oil reaches the eye surface. Your eye doctor will tailor treatment based on the stage of your MGD as well as any underlying medical condition you have.
MGD may lead to dry eye syndrome. In fact, 86% of dry eye patients have MGD. You may have dry eyes or dry eye syndrome if you’re suffering from some of the following symptoms:
Dry-feeling eyes
A burning or stinging sensation in your eyes
Eye redness or a bloodshot appearance
A sandy or gritty feeling under your eyelids
Itchy eyes
Tired eyes
Increased sensitivity to the light
Blurred vision
Discomfort wearing contact lenses
If you’re experiencing some of these symptoms, I highly suggest scheduling an appointment with your eye doctor. Making sure that your moisture levels are normal and you have proper tear function is a vital part of keeping your body healthy and your immune system balanced.
Causes
In a healthy eye, pressure from a blink expresses a small amount of oil from the Meibomian glands which is then distributed over the ocular surface as the eye opens. The ocular surface is the foundation for ocular comfort and visual quality. Other causes of MGD are hormone fluctuations, especially androgen deficiency, as well as other conditions such as demodex eyelash mites, rosacea, and other seborrheic skin conditions.
Treatment of MGD
LipiFlow is an in-office treatment that we offer that combines warm compress therapy and pulsed pressure to reduce dry eye syndrome and correct the balance of oils in the tear film. LipiFlow applies controlled heat to the inner eyelid and applies mild, intermittent pressure. This pressure will open and clear the blocked glands in order to allow the body to produce its natural production of oils. This will cause your eyes to stop being dry and alleviate the symptoms associated with dry eye syndrome. The unique mechanism of action of the LipiFlow Thermal Pulsation System has been shown to improve gland function in patients with MGD.
By simultaneous application of heat and peristaltic motion to the eyelid, obstructed meibum is safely liquefied and pushed out of the gland orifices. Subsequent to Lipiflow treatment, application of a natural substance, called Avenova, has been shown to be beneficial and extend the beneficial effect to the treatment. This natural substance is produced by neutrophils in the body in response to bacterial invaders and inflammation. It works to fight off microorganisms on the skin and mucous membranes, ensuring that the affected area is clean, and it also lowers the melting point of the meibum lipid, much like salt on snow. It is well known that clean eyelids can help alleviate the signs and symptoms of dry eyes and meibomian gland dysfunction. The office of Dr. Edwin M. Schottenstein has available this lid and lash antimicrobial spray solution, Avenova, which is designed to remove bacteria and debris around the eyes. Avenova also kills the coronavirus that causes COVID-19 on hard surfaces.
Long-term effects of untreated MGD
If left untreated, obstructed glands will reduce oil production, atrophy, and eventually drop out. Once a gland has atrophied completely, function is lost permanently, which leads to chronic discomfort and potentially sight-threatening damage to the ocular surface.
Dr. Edwin M. Schottenstein
Will I still be nearsighted after cataract surgery?
Your overall eye health
Whether you have astigmatism
Your current eyeglass prescription
The type of intraocular lens (IOL) used during your procedure
The IOL you choose matters.Traditional IOLs are monofocal. This means that they are only able to focus clearly at one visual point. If you choose a monofocal IOL, you may see clearly at distance, but still require glasses for near vision tasks after cataract surgery. Also, Traditional IOLs do not correct for astigmatism, which occurs if there is an irregular curvature of the cornea (the clear front cover of the eye over the lens, the iris and the pupil), causing vision problems. In other words, your nearsightedness can be corrected, but you may see blurry and still require glasses to focus your vision for both distance and near and vision tasks after cataract surgery. However, recent advances in IOL technology have resulted in a wide range of High Tech IOL options. Many High Tech IOLs are multifocal and provide you with the ability to focus clearly at multiple distances. In many instances, the use of a High Tech IOLs will reduce, if not eliminate entirely, your need for glasses after cataract surgery. Astigmatism can also be treated with laser assistance during cataract surgery. Other benefits of using High Tech (multifocal) IOLs include:
Better range of vision
Improved vision in a wide range of lighting conditions
Improved ability to read and perform other near vision tasks
Dr. Edwin M. Schottenstein offers several High Tech IOL options in addition to traditional monofocal IOLs. These include:
Toric IOLs — Toric IOLs are an excellent option if you have astigmatism, a condition that occurs as a result of having a cornea that is oval-shaped instead of round. Prior to the development of toric IOLs, patients with astigmatism always needed glasses after cataract surgery. By choosing a toric IOL, you may be able to eliminate your dependence on distance glasses after surgery, but you still will require glasses for near vision tasks.
Multifocal IOLs — Multifocal IOLs allow you to focus clearly at multiple distances. Not only will these IOLs be able to potentially eliminate the need for glasses after cataract surgery, but they are also an excellent option to combat the near vision issues associated with presbyopia.
Toric Multifocal IOLs — Toric multifocal IOLs are one of the newest and most advanced options available. They provide clear focus at all distances while allowing you to simultaneously correct for astigmatism.
It’s important to understand that High Tech IOLs are more expensive than traditional monofocal IOLs. Therefore, you’ll need to weigh the increased cost against the convenience benefits you’ll experience by reducing or eliminating your dependence on glasses. Dr. Edwin M. Schottenstein is one of New York City’s top board-certified ophthalmologists, completing years of rigorous training in specialized surgery, vision preservation, and restoration. His private practice, located on Manhattan’s Upper West Side, focuses on comprehensive ophthalmology, cataract surgery, glaucoma treatment, and helping patients with ophthalmic manifestations of diabetes. Visit his website at www.eyedoctornycnow.com for more information.
How long after cataract surgery can I sleep on my side?
Dr. Edwin M. Schottenstein
What surgery can treat glaucoma?
Trabeculectomy
With this type of surgery, the ophthalmologist will create a tiny one way valve opening in the top of your eye, under your eyelid where no one will see it. This valve opening permits your excess eye fluid to drain away, lowering your eye pressure.
Usually, you will be awake during this procedure, but you will get local numbing medicine and systemic relaxing medicine. You should plan to have someone to drive you home the same day.
Glaucoma Implant Surgery?
With this type of surgery, the ophthalmologist implants a tiny tube or shunt onto your eye. The tube helps extra fluid drain out of your eye, lowering your eye pressure.
With this procedure as well, usually you will be awake, but you will get local numbing medicine and systemic relaxing medicine. You should also ask someone to drive you home the same day.
Minimally Invasive Glaucoma Surgery (MIGS)?
The MIGS group of operations have been developed to reduce some of the complications of the previously aforementioned glaucoma surgeries. This group of distinctly different procedures also lowers eye pressure and are generally for mild glaucoma.
MIGS procedures work by using microscopic-sized equipment and tiny incisions. While they are safer and help you recover faster, some degree of effectiveness is also traded for the increased safety.
What happens after surgery?
Eye drops are prescribed to be taken for several weeks after surgery to help prevent infections and swelling. These eye drops are not the other glaucoma eye drops you may already be using, and in many cases those drops may be stopped.
While you recover, you may need to follow-up with your ophthalmologist to make sure your eye is healing well and avoid some activities, like heavy lifting.
For some people, the effect of surgery lasts a long time. For others, scarring requires that a surgery be performed again. You will need regular follow-up visits with your ophthalmologist.
Glaucoma surgery can have side effects, just like any operation. These side effects may include cataract, problems with the cornea (the clear surface layer of your eye), eye pressure becoming too low, and vision loss. Discuss surgery with your ophthalmologist. Together, you can make a treatment plan that’s right for you.
Do I have to buy glasses after an eye test?
Your doctor should check the pressure inside your eye, look at your pupils to see if they react to light properly, inspect your corneas, and peer into the back of your eye to evaluate the optic nerve and retina at a comprehensive eye examination.
Each part of the exam evaluates a different part of your eye. Eye exams are important for ensuring both your eye health and your overall health. Buying a new pair of glasses may or may not be part of this process.
How do you relax tired eyes?
Apply warm and cool compresses. Tired eyes often can be relieved with warm and cool compresses placed on your eyes. This remedy will not only improve the appearance of your eyes, but it feels great and gives you a chance to pamper yourself.
Address Allergies. If allergies are the cause of your tired eyes, take a topical antihistamine, which reduces redness, swelling and itchy feeling. Avoid other allergy triggers, like driving with your windows down or spending time outdoors during allergy season, to keep your eyes from looking and feeling tired.
Address dry eye syndrome. Your tired eyes may just be dry, and there are some easy things you can do to keep your eyes hydrated. Dry Eyes can be caused by several factors, including age, certain medications and too much screen time, all of which can make it difficult for your eyes to stay moist.
Make sure your prescription is updated. Your tired eyes may be the result of an outdated vision prescription. If it’s been a while since you had your eyes checked, find an eye doctor near you and book an appointment.
Outside of the last cause, the other causes of tires eyes are the result of dry eyes most often caused by Meibomian Gland Dysfunction. The Meibomian glands are what produce the lipids necessary for maintaining a proper amount of lubrication for your eyes. If these glands are malfunctioning, blocked, or just dying off, a severe case of dry eyes can set in. A treatment called LipiFlow is effective, and it can treat Meibomian Gland Dysfunction with immediate results. Dr. Schottenstein will often recommend LipiFlow treatment, especially if a patient has tried other dry tired eye treatments with little to no success—as he has seen great results from using LipiFlow treatment. An individual treatment session with LipiFlow usually takes 10-15 minutes, and depending on your situation, a single LipiFlow treatment can remain effective for up to two years.