Eye Center

About Us

The Medical City Eye Center is an eight-room complex housing outpatient ophthalmic equipment and outpatient clinics. It offers consultation services that include screening of ophthalmic conditions, elective and emergency consultation services, diagnostic procedures, and specialized therapeutic modalities (specifically laser procedures).

The Center is manned by an administrative nurse, a unit clerk and four ophthalmic technicians. It has a complete line of state-of-the-art equipment including diagnostic tools such as an automated perimeter, a fundus camera, YAG (Ytrrium Aluminum Garnet) and diode lasers.

Services

Cataract surgery screening tests and laser treatment

Pre-cataract surgery work-up

VERION® – an image guided system designed to offer improved precision, consistency and control in cataract refractive surgery

Optical coherence biometry, Zeiss IOLMaster®

A-scan ultrasound biometry

Ocular biometry

Biometry is an important component in determining intraocular lens (IOL) power for cataract surgery. It is a non-invasive procedure where axial length and anterior chamber depth are determined via ultrasonography and computed to determine IOL power.

Corneal topography: Topography provides a map of the corneal contour. Using a method similar to that of the Placido disk or Scheimpflug imaging, it provides additional information about the corneal surface and power. Corneal topography is particularly helpful if the patient has irregular astigmatism.

Oculyzer® Scheimpflug-based topography

Oculus Keratograph® Placido disc topography

Oculus Keratograph® tear film screening

TearLab Osmometer® tear osmolality testing

Tear film analysis

Tear film analysis is a non-invasive procedure and is used to determine dry eye. It provides an in-depth qualitative and quantitative analysis of the tear film on the corneal surface, as well as measuring tear osmolarity.

Corneal endothelial specular microscopy, Konan®: Specular microscopy is used to determine the number of corneal endothelial cells per square millimeter and evaluate their regularity. Because cataract surgery results in some loss of endothelial cells, the risk of postoperative corneal decompensation is increased if the preoperative endothelial cell count is low. Abnormal endothelial cell morphology, including enlargement (polymegathism) and irregularity (pleomorphism), may limit the cornea's ability to withstand stress.

Corneal pachymetry: Corneal pachymetry, a method used to measure corneal thickness, is useful for indirectly assessing the function of the endothelium. In general, significantly increased central corneal thickness in patients with endothelial dysfunction is associated with a greater risk of postoperative corneal decompensation.

Scheimpflug-based, Oculyzer®

Optical, Konan®

YAG laser capsulotomy: This involves the creation of an opening in the posterior capsule with the Nd:YAG laser. Indications for capsulotomy include diminished visual acuity, diplopia or glare secondary to capsular wrinkling, inadequate fundus view impairing diagnosis, monitoring or treatment of retinal pathology. Safe and successful laser capsulotomy involves accurate focusing and using the minimum energy required. Laser power is initially set at 1 mJ/pulse, and may be increased if necessary. A series of punctures are applied in a cruciate pattern using single-pulse shots, the first puncture aimed at the visual axis.

Diagnostic tests for retina conditions

Fundus photos: Uses a fundus camera to record color images of the condition of the interior surface of the eye, in order to document the presence of disorders and monitor their change over time. It uses a specialized low power microscope with an attached camera designed to photograph the interior surface of the eye, including the retina, retinal vasculature, optic disc, macula, and posterior pole.

Optos® ultra-wide field, non-mydriaticfundus photography

Zeiss Visucam® non-mydriatic fundus photography

Clarity Medical® Retcam (pediatric and bedside photos)

Fluorescein angiography, Zeiss Visucam®, Optos®

Fluorescein angiography allows the study of the circulation of the retina and choroid in normal and diseased states. Photographs of the retina are taken following intravenous injection of sodium flourescein.

Optical Coherence Tomography (OCT) imaging, Zeiss Cirrus® HD-OCT spectral domain technology

Non-invasive, non-contact imaging modality that that uses reflected light to produce a 2-dimensional image of the different layers in the retina. Spectral domain OCT delivers a 1000-fold improvement in speed over time domain OCTs. With SD-OCT images, the axial resolution is typically <7 micrometers, represented by 2048 pixels per A scan.

TMC Tele-Ophthalmology Program (remote interpretation of retinal images)

A program where retina test results, particularly of diabetic retinopathy, from remote locations in the TMC network can be interpreted, improving the quality and cost-efficiency of care.

B-scan ultrasonography

Brightness scan ultrasonography is used for evaluating intraocular structures when direct visualization is difficult or not possible because of eyelid problems, or opacities. It utilizes high frequency sound which bounces back forming a dimensional image of intraocular contents.

Color vision testing

The most common tests of color vision use colored tablets or diagrams. These depict colored numbers of figures that stand out from a background of colored dots. Individuals with defective color vision see either no pattern at all or an alternative pattern.

Treatment modalities for retina conditions

Panretinal photocoagulation (PRP): Photocoagulation uses a strong light source to coagulate tissue. Light energy is absorbed by the target tissue and converted into thermal energy. When the tissue temperature rises above 65°C, denaturation of tissue proteins and coagulative necrosis occur. Most surgeons currently perform photocoagulation with lasers spanning the visible light spectrum of 400-780 nm and venturing into the infrared wavelengths. Current posteriorsegment laser delivery systems include green, red, yellow, and infrared wavelengths. Panretinal scatter treatment to ablate ischemic tissue in order to eliminate retinal, iris, and disc neovascularization and to reduce the stimulus that causes continuing damage in proliferative diseases such as proliferative diabetic retinopathy and venous occlusive diseases.

Pascal® photocoagulator

532 nm diode

810 nm diode

a.     Laser Indirect Ophthalmoscopy (LIO)

LIO is used for treatment of retinopathy of prematurity (ROP). The laser is applied using the indirect ophthalmoscope in a pattern to the avascular retina in order to halt the progression of retinopathy of prematurity.

b.     Photodynamic therapy (PDT)

This uses the photosensitizing drug, Verteporfin for treating certain types of subfoveal choroidal neovascularization in age-related macular degeneration, some ocular tumors, and central serous chorioretinopathy. It utilizes a low-intensity laser which cause vascular thrombosis and capillary closure.

Intravitreal injection for Retina diseases such as Diabetic Retinopathy, age-related macular degeneration, vein occlusions.

This involves injection of anti-angiogenic agents (Bevacizumab, ranibizumab, aflibercept), steroid, and anti-microbials into the vitreous.

Glaucoma diagnostics and laser treatment

Visual field testing (perimetry): this measures differential light sensitivity, or the ability of the subject to distinguish a stimulus from a uniform background. It facilitates identification and quantification of abnormal fields and longitudinal assessment to detect glaucomatous progression. threshold sensitivity measurements are usually performed at a number of test  locations using white stimuli on a white background.

Zeiss Humphrey® field tester

Oculus Octopus® field analyzer

The most common programs for glaucoma testing are the central 24° and 30° programs, such as the Octopus 32 and Gland the Humphrey 24-2 and 30-2. These programs test the central field using a 6° grid. They test points 3° above and 3° below the horizontal midline and facilitate diagnosis of defects that respect this line. For patients with advanced visual field loss that threatens fixation, seriall0-2 orCS visual fields should be used. These visual fields concentrate on the central 8°-10° of the visual field, and test points every 1°- 2°, enabling the ophthalmologist to follow many more test points within the central island and improve the detection of progression.

Optic disk photography

Zeiss Visucam®: this features legendary ZEISS optics and non-mydriatic color fundus photography enabling you to photograph through pupils as small as 3.3mm. In addition the VISUCAMNM/FA features Fluorescein Angiography (Standard) and Indocyanine Green Angiography as well as Fundus Autofluorescence capture modes (Optional). Advanced features along with an easy stereo image mode are combined with intelligent auto functions that enable reproducible and intuitive imaging for every single patient eye.

Superior patient comfort, more efficient workflow and improved eye care: The VISUCAMNM/FA from ZEISS offers many advantages. The high-quality system provides everything you need for comprehensive assessment and management of typical eye diseases such as diabetic retinopathy, glaucoma and AMD in a single workstation.

(Source: http://www.zeiss.com/meditec/en_us/products---solutions/ophthalmology-optometry/glaucoma/diagnostics/fundus-imaging/visucam-nm-fa.html)

Optic disk Optical Coherence Tomography (OCT), Zeiss® Cirrus HD-OCT: used to acquire images of the retinal nerve fiber layer. Optical coherence tomography (OCT) uses interferometry and lowcoherence light to obtain a high-resolution cross section of biological structures. Time domain OCT instruments have an axial resolution of about 10 flm in the human eye and are able to yield an absolute measurement of nerve fiber layer thickness. In vivo OCT measurements appear to correlate with histologic measurements of the same tissues. With a resolution of 3-5flm, spectral domain OCT (SD-OCT) provides greatly increased resolution of images and is now clinically available.

Central Corneal Thickness (CCT)

Konan® specular microscope: Specular microscopy is used to determine the number of corneal endothelial cells per square millimeter and evaluate their regularity. Because cataract surgery results in some loss of endothelial cells, the risk of postoperative corneal decompensation is increased if the preoperative endothelial cell count is low. Abnormal endothelial cell morphology, including enlargement (polymegathism) and irregularity (pleomorphism), may limit the cornea's ability to withstand stress. “Specular microscopy is the study of the changes in different layers of the cornea under very high magnification (100 times greater than slit-lamp biomicroscopy) that is mainly being used to assess the endothelium. The image is analyzed with respect to cellular size, shape, density and distribution.

Central Corneal Thickness or Corneal Pachymetry:a method used to measure corneal thickness, is useful for indirectly assessing the function of the endothelium. In general, significantly increased central corneal thickness in patients with endothelial dysfunction is associated with a greater risk of postoperative corneal decompensation.

Oculus® CorVis system

Anterior chamber angle imaging, Wavelight® Oculyzer:

The WaveLight® Oculyzer™ II diagnostic device is based on the proven Pentacam HR technology, providing non-contact measurement and analysis of the complete anterior eye segment. Measurements are performed from the anterior surface of the cornea to the back of the lens. (http://www.alconsurgical.ca/Wavelight-Oculyzer-II.aspx)

Selective Laser Trabeculoplasty (SLT): Selective laser trabeculoplasty is an FDA-approved procedure in which the laser targets intracellular melanin. A frequency-doubled (532-nm) Q-switched Nd:YAG laser with a 400 -micrometer spot size is used to deliver 0.4-1.0 mJ of energy for 0.3 ns. Results of clinical studies suggest that the procedure is safe and effective, with lOP-lowering effects similar to those achieved with ALT (Argon Laser Trabeculoplasty). Histologic studies have shown that treatment with SLT causes less coagulative damage and fewer structural changes of the trabecular meshwork compared to treatment with ALT.

YAG Laser iridotomy: One of the treatments of angle closure due to pupillary block, whether primary or secondary is laser iridotomy.  This uses (Ytrrium Aluminum Garnet) laser and provides an alternate route for aqueous trapped in the posterior chamber to enter the anterior chamber, which then allows the iris to recede from its occlusion of the trabecular meshwork…” Iridotomy performed with the Q-switched Nd:YAG laser is preferred for most eyes. A patent iridotomy created with the Q-switched Nd:YAG laser generally requires fewer pulses and less energy than one created with an argon laser. Also, the effectiveness of the Q-switched Nd:YAG laser is not affected by iris color, and the iridotomy created by this laser does not close as often over the long term as one created by argon laser.

Special packaged procedures

Retina assessment:  FA and OCT

Fluorescein angiography (FA) allows study of the circulation of the retina and choroid in normal and diseased states. Photographs of the retina are taken after intravenous injection of sodium fluorescein, an orange-red crystalline hydrocarbon with a molecular weight of 376 that diffuses through most of the body fluids. It is available as 2-3 mL of 25% concentration or 5 mL of 10% concentration in a sterile aqueous solution. It is eliminated primarily through the liver and kidneys within 24- 36 hours via the urine. Eighty percent of the fluorescein is protein-bound, primarily to albumin, and not available for fluorescence; the remaining 20% is unbound and circulates in the vasculature and tissues of the retina and choroid, where it can be visualized.

Optical coherence tomography (OCT) is a noninvasive, noncontact imaging modality that produces micrometer-resolution, cross-sectional images of ocular tissue. OCT is based on imaging reflected light. The technique produces a 2-dimensional image of the backscattered light from different layers in the retina. OCT is useful for differentiating lamellar from pseudo- and full-thickness macular holes, diagnosing vitreomacular traction syndrome, differentiating various presentations of traction-related diabetic macular edema, monitoring the course of central serous chorioretinopathy, making treatment decisions in the management of age-related macular degeneration (AMD), and evaluating eyes for subtle subretinal fluid that is not visible with FA. A benefit of higher-resolution systems is the ability to better delineate retinal layers, including the internal, middle, and external limiting membranes and the junction between the inner and outer photoreceptor segments.

Oculus® Keratograph: A high-resolution color camera and integrated magnification changer open up entirely new perspectives in professional tear film analysis. The tear film can be assessed with both white and infrared light. Tear film volume (Tear Meniscus Height – TMH), tear film stability (Non-Invasive Keratograph Break-Up Time – NIKBUT) and Meibomian gland observation. 

Glaucoma Risk Profile:  VFT (same as perimetry), OCT, disc photo

Glaucoma Plus package:  VFT (same as perimetry), OCT, disc photo, CCT (same as corneal pachymetry)

Dry Eye assessment:  Oculus® Keratograph tear screening (tear breakup time or [BUT], meniscus height, Meibography, tear lipid qualitative assessment), TearLab® osmolarity testing, Schirmer’s test

(http://www.franjaocular.com/pdf/Dry_Eye_Guide_en_0915.pdf)

The tear film Break-Up Time (TBUT)determines pathology in the tear film or if there is presence of meibomian gland disorder. It is measured as follows:

a Fluorescein 2% or an impregnated fluorescein strip moistened with nonpreserved saline is instilled into the lower fornix.

 The patient is asked to blink several times.

The tear film is examined at the slit-lamp with a broad beam using the cobalt blue filter. After an interval, black spots or lines appear in the fluorescein stained film, indicating the formation of dry areas.  

The BUT is the interval between the last blink and the appearance of the first randomly distributed dry spot. A BUT of less than 10 seconds is abnormal.

The Schirmer test is a useful assessment of aqueous tear production and one of the tests for diagnosing dry eye disease. The test involves measuring the amount of wetting of a special (no. 41 Whatman) filter paper, 5 mm wide and 35 mm long. The test can be performed with or without topical anaesthesia.

Meibography: One method of evaluating the health of the meibomian glands is termed “meibography”, which relates to various methods of visualizing and imaging the meibomian glands.

Ethambutol is a bacteriostatic antimicrobial medication used as a first line defense against tuberculosis (TB) and Mycobacterium avium complex (MAC). Ethambutol toxicity is known to be dose related and has the potential to cause optic neuropathy in patients receiving this treatment. Thus, for those receiving this treatment, it is imperative that screening tests such as VFT, OCT and fundus photo should be performed to monitor for signs of optic neuropathy. (http://webeye.ophth.uiowa.edu/eyeforum/cases/75-ethambutol-toxicity-optic-neuropathy.htm)

Ethambutol toxicity screening:  VFT, OCT, fundus photo

Low vision evaluation:A person is considered to have low vision if their ability to perform basic daily tasks is affected by their ability to see. The term “Low Vision” usually means the best attainable visual acuity is somewhere around 20/50 or worse. A Low Vision Evaluation is an in-depth functional evaluation to determine if the current vision can be improved to do those things the person wants to do. The end result of the low vision evaluation will be to determine the lens power and device that is best suited to meet the patient’s needs. The low vision evaluation should explore the optical and non-optical systems that are currently available.” (https://www.abo-ncle.org/images/van_cleave.pdf)

Miscellaneous diagnostics:

Ocular microbial culture and sensitivity (C&S) testing

Stereovision testing: The Titmus test is one of the tests used to assess stereopsis. This consists of a three-dimensional Polaroid vectograph consisting of two plates in the form of a booklet viewed through Polaroid spectacles. On the right is a large fly, and on the left is a series of circles and animals. The test is performed at a distance of 40 cm.

Color vision testing (for employment): “Color vision assessment such as Ishihara chart testing if there is any suggestion of an optic neuropathy other than glaucoma. It consists of a test plate followed by sixteen plates each with a matrix of dots arranged to show a central shape or number which the subject is asked to identify. A color deficient person will only be able to identify some of the figures. Inability to identify the test plate (provided visual acuity is sufficient) indicates nonorganic visual loss.”

 

(SOURCES:

American Academy of Ophthalmology (AAO) 2015 to 2016

http://www.lasikhope.com/instrumentation/ocular-keratograph-topographer

http://www.themedicalcity.com/services/clinical_departments/ophthalmology/our-team

http://ophthalmology.med.ubc.ca/patient-care/ophthalmic-photography/color-fundus-photography/)

Our Team

Dr. Alfonso U. Bengzon – Unit Head, TMC Eye Center

 

Comprehensive Ophthalmology

Dr. Maricris L. Abulencia

Dr. Alan Gerard D. Austriaco

Dr. Edwin Raymond B. Balatbat

Dr. Denise Ramona V. Carbonell

Dr. Louie M. Chan

Dr. Leah Marie G. Continuado

Dr. Maya Fe N. Darjuan

Dr. Rosalyn P. Donato

Dr. Patrick Rey R. Echiverri

Dr. Enrique L. Enriquez

Dr. Corazon C. Estrella

Dr. Heriberto P. Guballa

Dr. Caryce Emma G. Juridico

Dr. Ma. Felicia Corazon E. Lacanilao

Dr. Dennis D. Lolarga

Dr. Pamela Aurora A. Monroy

Dr. Anthony Richard G. Nuñez

Dr. Glenn Q. Obligacion

Dr. Anna Maria F. Payawal-Lucero

Dr. Ma. Liza V. Sarenas

Dr. Debrelle Lou P. Siapno

Dr. Sonia Marie J. Silos

Dr. Stephen T. Sowy

Dr. Anne Caroline M. Tagle

 

External Diseases and Cornea

Dr. Maria Cecilia Gertrudis C. Agdeppa

Dr. Victor Jose L. Caparas

Dr. Ivo John S. Dualan

Dr. Karen B. Fernandez

Dr. Marichelle A. Isidro

Dr. Jennifer Ann B. Ko

Dr. Victor Michael R. Muñoz

Dr. Lawrence Marlon H. Pe

Dr. Johann Michael G. Reyes

Dr. Karen B. Reyes

Dr. Timothy Elbert R. Tan

Dr. Anna Lisa T. Yu-Mateo

 

Glaucoma

Dr. Pamela C. Allarey

Dr. Norman M. Aquino

Dr. Rommel D. Bautista

Dr. Rainier Victor A. Covar

Dr. Joseph Manuel M. Cruz

Dr. Maida B. De Castro

Dr. John Mark S. De Leon

Dr. Nilo Vincent II dG. FlorCruz

Dr. Alexander Joseph L. Reyes

Dr. Manolito R. Reyes

Dr. Joanna W. Sychingho-Ver

 

Uveitis

Dr. Cheryl Myla A. Arcinue

Dr. Fernandino A. Fontanilla

Dr. Egidio Jose S. Fortuna

 

Retina

Dr. Milagros H. Arroyo

Dr. Jesus Jacinto M. Bautista

Dr. Michael D. Del Rosario

Dr. Gregory G. Germar

Dr. Ronaldo R. Jarin

Dr. Noel C. Milla

Dr. Ricardo Tobias M. Papa

Dr. Arnold T. Salud

Dr. Edmin Michael G. Santos

Dr. Paolo Antonio S. Silva

Dr. Marie Robertina R.S. Tan

Dr. Sherman O. Valero

 

Plastic-Lacrimal-Orbit

Dr. Alfonso U. Bengzon

Dr. Jaime P. Capco

Dr. Jacqueline H. King

Dr. John Kenneth D. Lagunzad

Dr. Gary John V. Mercado (Ocular Oncology)

Dr. Manuel O. Palmero

Dr. Nonettee Y. Pasco-Rosete

Dr. Alex S. Sua (Ocular Pathology)

Dr. Sandra Joan R. Worak-Tan

 

 

Pediatric Ophthalmology and Strabismus

Dr. Joanne G. Bolinao

Dr. Fay Charmaine S. Cruz

Dr. Alvina Pauline D. Santiago

Dr. Patricia Yukiji J. Villa

 

Neuro-Ophthalmology

Dr. Sidney Y. Cheng

Dr. Richard C. Kho

 

Refractive

Dr. Margarita Nahleen N. Mejia

Dr. Adel Vergel D. Samson

 

Low Vision

Dr. Carmela H. Ongsiako-Isabela

Dr. Christine Therese A. Santos

 

Ocular Oncology

Dr. Emil Anthony T. Say