The practice of ophthalmology today is based on a growing body of medical knowledge and technology. With this growth has come the need for increased specialization and, in turn, a collaborative effort in the care of patients. Although small in size, the eye is complex and represents a variety of tissue types functioning together as a unit -- skin, muscle, glandular tissue, fat, pigmented tissue, collagen, protein, blood vessels, and brain tissue. The eye is located in a bony cavity called the orbit, which is surrounded by the sinuses, nose, and brain. With the multiplicity of tissue types and the complex structures around it, there is a need for sub-specialization and collaborative efforts with other specialists.

Today, the recognized ophthalmic subspecialties include ophthalmic plastic reconstructive and orbital surgery, corneal and external disease, glaucoma and uveitis, retina and vitreous, ophthalmic pathology, pediatric ophthalmology, and neuro-ophthalmology. These subspecialties are all represented in the Cizik Eye Clinic and collaboration among the subspecialties goes on routinely. Each expert in a subspecialty provides the cutting edge of ophthalmic knowledge to achieve an optimal outcome for the patient. Examples are many: the ophthalmic plastic surgeon consults with a corneal specialist regarding a burn victim, the pediatric ophthalmologist consults with a retinal specialist regarding a rare hereditary retinopathy, or the glaucoma specialist seeks the advice of the ophthalmic pathologist regarding cells he has removed from the eye of a glaucomatous patient. This is the practice of ophthalmology at its best. The eye is part of the whole patient, and we at the Cizik Eye Clinic constantly use the many physician specialists, laboratories, and the top-notch facilities of Memorial Hermann Hospital and The University of Texas Medical School at Houston.

Although we see the most serious problems that involve the eyes and visual system, including very serious traumatic conditions, all the physicians at the Cizik Eye Clinic welcome general ophthalmic patients. When an ophthalmologist is besieged with patients afflicted with rare ocular cancers, blinding diseases, or traumatic eye injuries that rob healthy eyes of sight, it is a pleasure to see normal, healthy eyes. The American Academy of Ophthalmology recommends routine eye examinations every one or two years for patients over the age of 55, at the onset of presbyopia (the loss of near focus with age, statistically at age 42), and as a child, when a vision problem is detected. Family members, friends, and other prospective patients often ask if we “also just check for vision." The answer is, “Yes!”

Patients who experience the most serious trauma from motor vehicle accidents, shotgun wounds, construction accidents, falls, and blows to the head are seen at Memorial Hermann Hospital’s Trauma Center because it is one of only two Level 1 trauma centers in Houston. When the eye is involved in one of these complex trauma cases, it is the ophthalmic plastic surgeon whose job it is to stabilize the wound and close open wounds, suture lacerations, decompress pressure, repair broken bones, prevent infection, and save the eye whenever possible. This is the realm of the ophthalmic plastic surgeon.

On a lighter note, the ophthalmic plastic surgeon is the one to see when considering cosmetic surgery of the eyelids--blepharoplasty. In the hands of a less skilled surgeon, plastic surgery around the eyes can result in eyelids that close incompletely and create bothersome and sometimes serious eye problems. Cizik Eye Clinic is fortunate to have one of the most skilled ophthalmic plastic surgeons in Houston, Dr. Sherif Khalil.

You hear about it on television and radio and read all about it in the newspapers. Ophthalmology has long been a leader, even a pioneer, in laser surgery, but the laser surgery that is the buzz these days is refractive laser surgery. One may decide he wants surgery only to find that, in our professional opinion, the procedure would not be prudent. At the Cizik Eye Clinic, our goal is to perform this elective procedure only when it is appropriate. If you want the honest truth, make an appointment with one of our experts at the Cizik Eye Clinic. Richard W. Yee, MD, is Director of the Hermann LADARVision Center. Drs. Robert M. Feldman, Judianne Kellaway, Helen Mintz-Hittner, Sherif Khalil, and Nan Wang also perform the procedure -- when it's in a patient’s best interest. Dr. Ruiz often tells patients, "It's the only surgery I've seen in all my years of practice that looking through the microscope on the first day post-operatively, you often can't tell the patient has had surgery."

There are many types of glaucomas: open-angle, closed-angle, narrow-angle, juvenile, secondary, traumatic, and others, but the definition of glaucoma is always the same: elevated pressure inside the eye, that damages the optic nerve. Some cases of glaucoma can be painful and cause patients to seek medical care immediately. However, in the vast majority of cases, glaucoma is a painless, silent process that slowly and insidiously robs a patient of his or her peripheral vision. Unfortunately, by the time a patient becomes aware of vision loss, damage is advanced--and irreversible. Most glaucomas are in the purview of the general ophthalmologist; however, some of the more aggressive and elusive glaucomas require an expert. At the Cizik Eye Clinic, Robert M. Feldman, MD, is our expert and is in charge of the glaucoma service.

A cataract is a clouding of the normally clear lens of the eye. It can be compared to a window that is frosted or fogged with steam. There are many causes of cataracts, the most common is related to aging. The fact is, cataracts are like wrinkles and gray hair--if you live long enough, you’ll get them. However, only a small percentage of cataracts require surgery. Removal of a cataract should be considered when the cataract causes enough vision loss to interfere with one’s daily activities --for instance, you no longer drive at night, you can't see the television clearly, shopping is no longer fun, and glasses won't improve your vision. More than 1.4 million people have cataract surgery each year in the United States, and 95% of these surgeries are without complications. After cataract surgery, one may return almost immediately to all but the most strenuous activities. You will need to instill eye drops and make two or three post-operative visits. Cataract surgery is a highly successful procedure. Improved vision should result in over 90% of cases. True, complications can occur, but they are rare and most are managed successfully. With few exceptions, all ophthalmologists perform cataract surgery, including the physicians at the Cizik Eye Clinic.

Pediatric ophthalmologists are physicians who are specialists trained to diagnose and treat problems that affect children's eyes, including strabismus (crossed eyes), amblyopia (lazy eye), and retinoblastoma (a life threatening ocular cancer). Treating eye diseases in children differs substantially from treating adults but includes prescriptions for eyeglasses or contact lens, medications, and surgical intervention--including refractive laser surgeries.

Today, clinically useful estimates of visual acuity can be made on an infant as young as three or four months by evaluation of the child's ability to follow a light or moving object. Refined assessments of an infant's vision can be obtained through behavioral responses when the infant is shown objects of various sizes or by sophisticated tests, such as electroretinograms, that analyze the retina's response to light. In unusual cases, general anesthesia may be required for a thorough eye examination in children under two years of age.

Toys, games, child-sized furniture, colorful pictures, and storybooks are popular items found in the pediatric ophthalmologist’s office. Age-appropriate surroundings are important in establishing rapport with young patients, and they help facilitate the examination process. Toys are used as diagnostic tools to attract the child's attention. Cartoons are shown on a video screen to make the child look in the desired direction. Visual acuity charts showing drawings of objects familiar to children are used, such as birthday cakes and horses, instead of standard letters used for adults. These specialized tools, along with advanced technology, enable ophthalmologists to identify eye abnormalities in children early.

The secret to working with children is to eliminate fears and rely on their natural curiosity and interest in new experiences. We are fortunate to have on our faculty two of Houston's most respected pediatric ophthalmologists – Malcolm L. Mazow, MD, and Helen Mintz-Hittner, MD.