My Doctor Online The Permanente Medical Group
Are you having back pain with any of the following?
- Severe pain, weakness or tingling in your leg(s).
- Difficulty stopping urination or loss of control of bladder or bowels.
- Unexplained fever, nausea or vomiting.
- A history of cancer or unexplained weight loss.
We understand that you are experiencing one or more of the health issues that might be impacting your back pain.
We recommend that you discuss these health issues with your doctor before proceeding with this program.
Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.
Arthur Glover, MD
Ophthalmology: Oculoplastic
Welcome to My Doctor Online, a website that my colleagues and I have developed to make it easier for us to interact with you, take care of many of your healthcare needs and answer questions you may have regarding oculoplastic surgery. I'm eager to work with you to make your experience at Kaiser Permanente a positive one. Because the better connected we are, the healthier you are.
Quick Links
- Prepare for You Procedure (Emmi)
- Oculoplasty
- Surgery Instructions (Before & After)
- Common Eye Conditions
- KP Videos For Cataract Patients
- American Academy of Ophthalmology
- Cataract Surgery
- Laser Vision Correction
- National Eye Institute
- Prepare for Your Procedure - Emmi
- Vision Essentials
General References
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Keratoconus (Cone-Shaped Cornea) [Read/Print full article]
Overview
Keratoconus (pronounced ker-uh-toh-cone-uhs) is a genetic eye condition in which the cornea, or the clear, outer front dome of the eye, becomes thinner and weaker. Over time, the weakened cornea starts to bulge outwards in a cone shape, due to the natural pressure exerted on it from inside the eye. This coning eventually leads to scarring on the cornea and astigmatism - blurry vision caused by the distortion of the cornea. People with keratoconus often find their glasses prescriptions change frequently and notice worsening glare and light sensitivity.
Keratoconus typically affects people in their teens or early twenties and progresses until they reach their mid thirties, at which point it may stabilize.
Additional References:
- External Link to The Discovery Eye Foundation
- External Link to The National Keratoconus Foundation
Causes, Symptoms and Diagnosis
Causes and symptoms
Keratoconus is a genetic condition that weakens the corneal tissue. We do not know the exact cause. Since the condition is inherited we cannot prevent it from developing. The early signs are subtle and easily missed during eye exams. As the condition progresses, your eyesight becomes blurred and distorted and cannot be corrected with glasses.
Diagnosis
The definitive way to diagnose keratoconus is with a corneal topography. This is a simple test which maps the surface of the cornea and can detect early cone formation. As the condition progresses, the diagnosis becomes more obvious.
Treatments
Initially, the astigmatism can be corrected with glasses. However, as the cornea continues to bulge outwards, glasses are no longer effective and a rigid contact lens is required. If the keratoconus continues to get significantly worse and scarring develops, the only definitive treatment is a corneal transplant. However, in most cases, the cornea stabilizes before severe coning occurs, in which case surgery is not needed.
While glasses and contact lenses are relatively easy and safe options, corneal transplants often carry significant risks. Research is underway to find non-invasive, or minimally invasive treatment options for patients with advanced keratoconus.
New Treatments
Some of the newer treatment approaches include the following:
Implants
Thin plastic implants are inserted into the cornea to flatten it back into its correct shape. We offer this procedure at several of our medical centers in Northern California.
Anterior lamellar grafts
- This is a partial corneal transplant that replaces the distorted front of the cornea with healthy donor tissue but preserves the normal back of the cornea.
- The advantage of this procedure is that the eye is stronger, recovery is quicker and there is very little chance of rejection which occurs more frequently in a full thickness transplant.
- The disadvantage of this procedure is that the final vision is often not as good as a full thickness transplant.
- We are currently evaluating this procedure and the visual outcomes. Early results have been promising.
Riboflavin (Vitamin B2) and UV light
- Research regarding the use of riboflavin (Vitamin B2) and UV light to strengthen corneal tissue is ongoing.
- The procedure, called riboflavin crosslinking, may be useful in early stages of keratoconus.
- Riboflavin crosslinking is currently being performed in Europe. In the US, an FDA trial to assess the effectiveness of this therapy, and any associated complications is underway. We await the outcome of the FDA study and will offer this therapy if it is shown to be safe and effective.
Lifestyle Changes and Management
Most people with Keratoconus can function normally for many years by using glasses and/or contact lenses. We will check your eyes regularly and it is important to let us know if you have sudden vision changes. It is also important to note that if you have keratoconus, glasses and contact lenses are the best options for maximizing your vision. Keratoconus patients should never have LASIK or any other corneal refractive surgery.
Your Care with Me
If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.
If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.
During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.
In many cases, the cornea stabilizes before severe coning occurs and no further treatment is needed. However, if your cornea continues to get worse, you may need a surgical procedure to improve, control, or eradicate your keratoconus.
If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.
If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.
If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.
Coordinating Your Care
Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.
Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.
When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.
If you come to an office visit
- At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need.
- At the end of your visit, you may receive a document called the "After Visit Summary" that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed. You can also view it online under Past Visits.
- To help you prepare for your visit, please see additional details under Office Visit.
If I prescribe medications
We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.
If refills are needed in the future, you can:- Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
- Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed
For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.
If I refer you to another specialty colleague
If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.
If surgery or a procedure is a treatment option
I will recommend you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.
If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.
Convenient Resources for You
As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.
My Doctor Online is available at any time that is most convenient for you. From my home page you can:
Manage your care securely
- View and compose secure e-mail messages.
- Manage your prescriptions.
- View your past visits and test results.
- View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
- Read about causes, symptoms, treatments and procedures.
- Find interactive health tools, videos, and podcasts to help you manage your condition.
- View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
- Locate health education classes and support groups offered at every medical center.
- Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
- View your Preventive Services to see whether you are due for a routine screening or updated immunization.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.