Services & Procedures

No-Stitch Cataract Surgery | Glaucoma | Diabetic Retinotherapy | Macular Degernation | Dry Eye | Dry Eye Treatments | Eye Exams | Optical Shop

At the office of Peter J. Kelly, M.D. and Leonardo J. Velázquez, M.D., we have an enthusiastic team of technicians and administrative staff to provide you with a comfortable and efficient experience as we attend to your eye care needs.

If you ever have any questions or concerns regarding your eyecare needs, or would like to comment on any aspect of the services we provide, please contact us at any time.

No-Stitch Cataract Surgery

Cataracts are the leading cause of reversible vision loss among adults age 60 and older, impairing vision and making everyday activities increasingly difficult. They are an opacity or clouding of the normally clear lens of the eye, which lies behind the iris and the pupil. This clear lens focuses light onto the retina at the back of the eye, which in turn sends information to the brain where it’s interpreted into the images we see. As the natural lens becomes cloudy, it inhibits or diminishes the passage of light to the retina, often leaving patients feeling as though they are looking through a frosted or “fogged” windshield. Colors may appear dull and reading in low light becomes difficult.  Glare and halos around headlights often increase, causing night driving to become more challenging.

Cataracts are most commonly caused by the natural aging of the lens.  Other causes include diabetes, trauma, sun exposure, toxic chemicals and certain drugs (e.g. steroids).

Ophthalmologists must dilate the pupil to examine the lens in order to determine if a cataract is present. Once it has been diagnosed, the natural lens must be surgically removed and replaced with an artificial lens called an intraocular lens (IOL) in order to restore clear vision. There is no known treatment to prevent the development of cataracts.

Discussing your visual goals following the surgery is an important discussion that occurs during the exam. With the removal of the natural lens, we have the opportunity to replace it with a variety of lenses and lens implant powers, offering a wide range of vision outcomes after.

Dr. Kelly & Dr. Velázquez utilize the monofocal, monofocal toric, multifocal and multifocal toric intraocular lenses.

Many patients opt for standard surgery, which simply means they are choosing a monofocal lens implant for the procedure. A monofocal lens offers one visual goal following the surgery. For instance, patients who love to golf or love shooting sports and want to see as clearly as possible at long distances may choose a monofocal lens, set to correct as best the lens can, their distance vision. Since the monofocal lens can only correct one goal, this particular patient will need assistance in the near and intermediate-range, so they will likely be wearing reading glasses for near vision tasks.

On the other hand, if a patient does a lot of needlework and wants to correct his/her vision the best they can in the near range, they will need to use glasses or some sort of correction for their distance vision.

Similarly, patients who desire good distance or good near vision but have astigmatism, can achieve the same results of the monofocal lens discussed above by choosing a monofocal toric lens that also reduces astigmatism.

MonoVision can be a great option for patients interested in reducing their dependence on glasses for both near and far distances. Utilizing the same standard monofocal or monofocal toric lens mentioned above, one eye will have a lens placed to correct distance vision, while the other eye will be corrected for near vision. Vision is a function of the brain and not everyone is able to adapt to this monovision correction. We recommend trying contact lenses first to simulate monovision correction to ensure your brain can function and adapt to this type of modification.

Multifocal and multifocal toric lenses (“trifocals”) offer the potential to provide clear vision for near, intermediate, and far distances without glasses after cataract surgery.

Please keep in mind that these lenses can be chosen to correct whatever visual goal you prefer, but it’s never a guarantee that you’ll be correction-free at that distance. Even if the lens corrects your distance vision the best it can, it’s possible you’ll still need glasses or correction for your distance vision, depending on your desires and needs.

Dr. Kelly and Dr. Velázquez perform the most advanced cataract surgery known as phacoemulsification. The surgery is performed on an outpatient basis under local or topical anesthesia. A complete physical examination is required prior to surgery to ensure the patient’s overall health. During surgery, using high energy sound waves through an ultrasound emitting probe, the cataract is broken into tiny, microscopic pieces and gently suctioned from the eye. The procedure is performed through a small incision, which is self-sealing and requires no stitching. Not only is this safer for the patient, but it also produces less discomfort and recovery is quicker. An artificial replacement lens is then inserted through the incision and unfolded in place. This intraocular lens focuses light rays directly onto the retina to produce clear, sharp images just as the natural lens did. Most people experience improved vision immediately following surgery and are able to return to their normal activities within a couple of days.

To find out if you are a candidate for cataract surgery and which lens is best for you, you will need a complete eye exam by Dr. Kelly or Dr. Velazquez. Please call the office at 413-283-3511 to schedule an appointment.

^ Back to Top

Glaucoma

Glaucoma is the third leading cause of blindness and a leading cause of irreversible blindness worldwide. It is a group of eye diseases that gradually steal sight without warning, in most cases. In the early stages, there may be no obvious symptoms. Most people with glaucoma have a slowly progressive, but irreversible course of deterioration. Vision loss is caused by damage to the optic nerve. Although intraocular pressure (IOP) is the major risk factor, other factors are involved because even people with “normal” levels of pressure can experience vision loss from glaucoma.

Certain individuals can sustain a degree of IOP elevation without the development of glaucoma and are referred to as having Ocular Hypertension (OHT), although as a group such individuals remain at increased risk of developing glaucoma with time. 

There is no cure for glaucoma.  However, eyedrops or surgery can slow or prevent further vision loss.  The appropriate treatment depends on the type of glaucoma among other factors.  Early detection is vital to stopping the progress of the disease.

Dr. Kelly and Dr. Velázquez offer a progressive laser treatment for glaucoma called Selective Laser Trabeculoplasty or SLT.  Intraocular pressure in the eye is reduced using this laser treatment.  SLT is an office procedure using anesthetic drops to numb your eye and only takes a few minutes.  The process stimulates the body’s own healing response to lower the pressure in the eye.

^ Back to Top

Diabetic Retinopathy

Diabetic retinopathy is the most common cause of vision loss for people with diabetes. Your risk increases the longer you have diabetes. Over time, having too much sugar in your blood can damage your retina — the part of your eye that detects light and sends signals to your brain through a nerve in the back of your eye (optic nerve). It is important for you to get a comprehensive dilated eye exam at least once a year. Eye doctors can check for diabetic retinopathy as part of a dilated eye exam. The exam is simple and painless — your doctor will give you some eye drops to dilate (widen) your pupil and then check your eyes for diabetic retinopathy and other eye problems.

The early stages of diabetic retinopathy usually don’t have any symptoms. Some people notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go.

In later stages of the disease, blood vessels in the retina start to bleed into the vitreous (gel-like fluid in the center of the eye). If this happens, you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own — but it’s important to get treatment right away. Without treatment, the bleeding can happen again, get worse, or cause scarring.

Diabetes can also make you more likely to develop several other eye conditions:

Cataracts. Having diabetes makes you 2 to 5 times more likely to develop cataracts. It also makes you more likely to get them at a younger age.

Open-angle glaucoma. Having diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma.

Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels as close to normal as possible. You can do this by getting regular physical activity, eating healthy, and carefully following your doctor’s instructions for your insulin or other diabetes medicines.  

It is important for patients who have been diagnosed with diabetes to be carefully evaluated yearly by an Ophthalmologist or eye M.D.  

^ Back to Top

Macular Degeneration

Age-related Macular Degeneration (AMD) is the leading cause of vision loss in people over age 50, affecting more than 10 million Americans – more than cataracts and glaucoma combined. Presently, it is considered an incurable eye disease. There are two basic types of AMD: “dry” (85%-90%) and “wet” (10-15%).

AMD is caused by the deterioration of the central portion of the retina, the inside back layer of the eye that records the images we see and sends them via the optic nerve from the eye to the brain. The retina’s central portion, known as the macula, is responsible for focusing central vision in the eye, and it controls our ability to read, drive a car, recognize faces or colors, and see objects in fine detail.

In the early stages, AMD may have no symptoms at all. When the disease progresses, the symptoms are:

• Distortion (warping) of straight lines
• A decrease in the intensity or brightness of colors

As the macular degeneration progresses, AMD symptoms include:

• A gradual or sudden loss of central vision, or
• Dark, blurry areas in the center of vision

The primary risk factor for AMD is age — the older you are, the greater the risk.

People at a greater risk of AMD are those with family history of AMD, women and people of European descent.

Lifestyle factors that are also known to increase your risk of AMD: cigarette smoking, obesity, hypertension, excessive sun exposure and diet deficient in fruits and vegetables.

There is currently no known cure for Macular Degeneration, but there are things you can do to reduce your risk and possibly slow the progression once you’ve been diagnosed. For example, one can pursue lifestyle changes like dieting (rich in fruits and green-leafy vegetables), exercise, avoiding smoking, and protecting your eyes from ultraviolet light.

It is important for patients who have been diagnosed with Macular Degeneration to be carefully evaluated once or twice a year by an Ophthalmologist or eye M.D.

^ Back to Top

Dry Eye Disease

The eye depends on the flow of tears to provide constant moisture and lubrication to maintain vision and comfort.  Tears are a combination of water for moisture, oils for lubrication, mucus for even spreading and antibodies and special proteins for resistance to infection.  These components are secreted by special glands located around the eye.  When there is an imbalance in this tear system, you may experience dry eyes. When tears do not adequately lubricate your eyes, you may experience pain, light sensitivity, a gritty sensation, a feeling of a foreign body or sand in the eye, itching, redness or blurring of vision.

Sometimes, a person with dry eyes will have excess tears running down the cheeks, which may seem confusing.  This happens when the eye isn’t getting enough lubrication.  The eye sends a distress signal through the nervous system for more lubrication.  In response the eye is flooded with tears to try to compensate for the underlying dryness.  However, these tears are mostly water and do not have the lubricating qualities or the rich composition of normal tears.  They will wash debris away, but they will not coat the eye surface properly.

In addition to an imbalance in the tear-flow system of the eye, dry eyes can be caused by situations that dry out the tear film.  This can be due to dry air from air conditioning, heat or other environmental conditions.  Other condition that may cause dry eyes are:

• The natural aging process, especially menopause.
• Side effects of certain medications such as antihistamines and birth control pills.
• Diseases that affect the ability to make tears, such as Sjogren’s syndrome,   Rheumatoid Arthritis and collagen vascular diseases such as Lupus.
• Structural problems with the eyelids that don’t allow them to close properly.

^ Back to Top

Although dry eyes cannot be cured, there are a number of steps that can be taken to treat them.

Artificial tear drops and ointments.   The use of artificial teardrops is the primary treatment for dry eye.  Artificial teardrops are available over the counter.  Since no one drop works for everyone, you might have to experiment to find the drop that works best for you.  If you have chronic dry eye, it is important to use the drops even when your eyes feel fine to keep them lubricated. 

Temporary punctual occlusion.  Sometimes it is necessary to close the ducts that drain tears out of the eye.  A plug is inserted into the tear duct that will dissolve over a few days.  This is a painless procedure and will determine whether permanent plugs can provide an adequate supply of tears.

Permanent punctual occlusion.  If temporary plugs work well, then silicone plugs (punctual occlusion) may be used.  The plugs will hold tears around the eyes as long as they are in place.  They can be removed and rarely, come out spontaneously.  Many patients find that the plugs improve comfort and reduce the need for artificial tears.

Restasis or Xiidra. FDA-approved prescription eyedrops for the symptoms and signs of dry eye disease by reducing inflammation and helping your eyes increase their own tear production with continued use.

Other medications.  Other medications, including topical steroids, may also be beneficial in some cases.

^ Back to Top

Eye Exams - What to Expect

Dr. Kelly, Dr. Velázquez and Dr. Dorans use a wide variety of tests and procedures to examine your eyes.  These tests range from simple ones, like having you read an eye chart, to complex tests, such as using a high-powered lens to visualize the tiny structures inside of your eyes.

A comprehensive eye exam can take an hour or more depending on the complexity of tests required to fully evaluate your vision and the health of your eyes.

The following are a few tests you are likely to encounter during a routine comprehensive eye exam:

Visual Acuity Tests: Visual acuity tests measure the sharpness of your vision.  These are performed using a projected eye chart to measure your distance visual acuity and a small, hand-held chart to measure your near vision.

Color Blindness Test: This screening test is performed early in a comprehensive eye exam to rule out color blindness.

Cover Test: While focusing on an object across the room, each of your eyes, alternately, will be covered while you stare at the target.

Retinoscopy: This test is performed to obtain an approximation of your eyeglass prescription.  It is especially useful for children and patients who are unable to accurately answer questions.

Refraction: A refraction determines your exact eyeglass prescription.

Slit-Lamp Examination: The slit lamp is an instrument used to examine the health of your eyes.

Glaucoma Test: This test measures the pressure in your eyes.

Pupil Dilation: Eye drops (dilating eyedrops) are instilled in your eyes to enlarge your pupils to get a better view of the eye’s internal structures.  When your pupils are dilated (it usually takes at least 10 minutes), you may be sensitive to light which can last several hours.  We recommend that you bring sunglasses to wear after the exam or even bring a driver.

^ Back to Top

Optical Shop

We offer full service optical shops in our Palmer and Ludlow offices.  We have our own laboratory that allows us to control the quality and workmanship of the eyeglasses we produce.  We use only the finest lens materials available, whether for progressive lenses, high index lenses (thin lenses) or standard bifocals and single vision.

We have hundreds of frames to choose from to accommodate every budget.  We carry many of the most popular designer lines and have a full selection for men, women and children.  We also carry a large selection of sunglasses featuring Ray Ban, Maui Jim, Bolle’, Serengeti and Carrera.

We are also a distributor of Bushnell Optics binoculars, range finders and telescopes.  We also carry all sorts of sport glasses and we are a distributor for AO industrial safety OSHA-approved eyewear.

Please feel free to come in and try on our frames and ask any questions that you may have about eyewear.

^ Back to Top