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At Hiemstra Optical, we go beyond 20/20. Our doctors are trained to diagnose, treat, and monitor chronic ocular conditions — the kind that don’t resolve on their own and that can cause serious, permanent harm if left unmanaged.
Conditions like dry eye disease, glaucoma, and diabetic retinopathy are common. They are also frequently undertreated, either because patients don’t recognize the early signs or because they assume an optometrist can’t help. We can. Many of our patients with chronic eye conditions see us more often than they see their primary care physician — and for good reason.
If you have a diagnosed eye condition, a systemic disease with known ocular effects, or a new symptom that concerns you, this is what we do.
Dry Eye Disease Management
Dry eye disease is not just an annoyance — it is a chronic inflammatory condition of the ocular surface that affects tens of millions of Americans. For many patients, it is also underdiagnosed: symptoms like fluctuating vision, light sensitivity, and paradoxical excess tearing are not always recognized as dry eye, and the condition is frequently dismissed as minor when it is anything but.
Untreated dry eye disease can damage the corneal surface over time, impair visual quality, and significantly reduce quality of life. We treat it with a structured, evidence-based approach.
Understanding the Two Types
- Aqueous Deficient Dry Eye: The lacrimal glands are not producing adequate tear volume. Less common but often more severe, and sometimes associated with autoimmune conditions like Sjogren’s syndrome.
- Evaporative Dry Eye (MGD): The meibomian glands — oil-producing glands along the eyelid margin — are not secreting properly, causing the tear film to evaporate too quickly. This accounts for the majority of dry eye cases and is frequently tied to screen time, contact lens wear, and environmental factors.
Diagnostics
- Tear film assessment: We evaluate tear breakup time (TBUT) and tear volume to understand the stability of your tear film.
- Meibomian gland evaluation: We assess the function and expression of the meibomian glands — a key step in identifying evaporative dry eye.
- Ocular surface staining: Specialized dyes allow us to identify areas of corneal and conjunctival damage caused by chronic dryness.
- Symptom scoring: Standardized questionnaires help us track severity and measure treatment progress over time.
Treatment
- Preservative-free lubricants: A first-line intervention for mild-to-moderate symptoms. We help you find the right formulation — gel, drop, or ointment — for your specific pattern of dryness.
- Warm compresses & eyelid hygiene: For MGD-related dry eye, consistent thermal therapy and lid scrubs can meaningfully improve meibomian gland function over time.
- Punctal plugs: Small, biocompatible inserts placed in the tear drainage openings to retain more moisture on the eye’s surface. A quick, in-office procedure.
- Prescription anti-inflammatory therapy: Cyclosporine (Restasis, Cequa) and lifitegrast (Xiidra) address the inflammatory component of dry eye directly — often producing meaningful improvement in patients who have not responded to lubricants alone.
- Omega-3 supplementation: Evidence supports the use of high-quality omega-3 fatty acids in improving meibomian gland function. We can discuss appropriate dosing as part of a comprehensive plan.
Glaucoma Management
Glaucoma is one of the leading causes of irreversible blindness worldwide — and it earns its nickname as the “silent thief of sight” honestly. In its most common form, open-angle glaucoma, there are no symptoms in the early stages: no pain, no visual disturbance, no warning. By the time a patient notices something is wrong, significant and unrecoverable damage to the optic nerve may have already occurred.
We are equipped to detect, monitor, and manage glaucoma — and to coordinate surgical referrals when the condition advances beyond what medical management can address.
Diagnostic Tools
- Intraocular Pressure (IOP) Monitoring: Elevated eye pressure is the primary modifiable risk factor for glaucoma. We monitor IOP at each visit, knowing that a single reading is never the whole picture.
- Optical Coherence Tomography (OCT): Generates detailed cross-sections of the retinal nerve fiber layer and optic nerve head, detecting microscopic structural changes that often precede measurable vision loss by years.
- Visual Field Testing: Automated perimetry maps the full extent of peripheral vision, identifying functional losses characteristic of glaucomatous damage. Serial visual fields over time tell us whether the condition is stable or progressing.
- Optic Nerve Assessment: Direct examination and photography of the optic nerve head allows us to track changes in cup-to-disc ratio, notching, and pallor over time.
- Pachymetry (Corneal Thickness): Corneal thickness affects IOP readings and is an independent risk factor for glaucoma progression.
Treatment & Management
- Medicated eye drops: First-line therapy for most patients. Prostaglandin analogues, beta-blockers, alpha agonists, and carbonic anhydrase inhibitors work through different mechanisms to reduce IOP. We find the right combination with the fewest side effects.
- Adherence support: The most common reason glaucoma progresses is inconsistent medication use. We work with patients to build sustainable routines and address barriers like cost and side effects.
- Surgical referral: When IOP cannot be controlled medically, or when the optic nerve continues to show damage despite treatment, we coordinate prompt referral to an ophthalmologist for laser therapy, trabeculectomy, or minimally invasive glaucoma surgery (MIGS).
Diabetic Eye Management
Diabetes is one of the leading causes of new blindness in adults in the United States — but the vision loss it causes is largely preventable. The key is early detection and consistent monitoring, long before symptoms appear.
Diabetic eye disease produces no symptoms in its early stages. Patients can have significant retinal changes on examination while experiencing perfectly normal vision. By the time vision is affected, the disease may be at an advanced stage. This is why annual dilated eye exams are not optional for patients with diabetes — they are part of the medical management of the condition itself.
How Diabetes Affects the Eye
- Diabetic Retinopathy: High blood sugar damages retinal blood vessels. In nonproliferative stages, vessels leak, swell, or close off. In proliferative stages, abnormal new blood vessels grow on the retina, creating serious risk of bleeding and retinal detachment.
- Diabetic Macular Edema (DME): Fluid leaks into the macula — the area responsible for sharp, central vision — causing swelling that directly impairs visual acuity. DME can occur at any stage of retinopathy.
- Vitreous Hemorrhage: Fragile new blood vessels can rupture, flooding the vitreous with blood and causing sudden, dramatic vision changes. A medical urgency requiring prompt evaluation.
- Cataracts & Glaucoma: Patients with diabetes develop both conditions at higher rates and often earlier than the general population.
Our Approach
- Dilated retinal exams: Thorough dilation is essential for a complete view of the peripheral retina. We examine the optic nerve, macula, blood vessels, and retinal periphery at every diabetic visit.
- OCT imaging: Provides detailed cross-sectional imaging of the macula — critical for detecting diabetic macular edema even when not yet visible on examination.
- Coordinated care: We send detailed clinical reports to your primary care physician or endocrinologist after every diabetic eye exam. Eye findings are valuable data for overall diabetes management.
- Referral when indicated: If we detect proliferative retinopathy, significant DME, or vitreous hemorrhage, we coordinate urgent referral to a retinal specialist for laser treatment or intravitreal injections.
Medication Monitoring & Acute Eye Care
Two distinct but related services fall under this heading: proactive monitoring for patients whose systemic medications carry known ocular risks, and same-visit care for acute conditions that need prompt attention.
Medication Toxicity Monitoring
Many commonly prescribed medications can affect the eyes — sometimes subtly, sometimes significantly. If you take any of the following, your eyes should be monitored regularly:
- Hydroxychloroquine (Plaquenil): Used for lupus, rheumatoid arthritis, and other autoimmune conditions. Long-term use can cause bull’s-eye maculopathy. We provide baseline exams within the first year and annual screenings thereafter using OCT and visual field testing per AAO guidelines.
- Amiodarone: A cardiac medication associated with corneal deposits and, more rarely, amiodarone-induced optic neuropathy.
- Tamoxifen: Used in breast cancer treatment. Associated with crystalline macular deposits and retinal toxicity with long-term use.
- Isotretinoin (Accutane): Can cause or worsen dry eye and reduce night vision. Rare cases involve intracranial hypertension with associated visual changes.
- Corticosteroids (systemic): Long-term steroid use significantly increases the risk of both cataracts and glaucoma. Regular pressure checks are indicated.
If you are on a medication not listed here and want to know whether it carries ocular risks, bring it to your next appointment. We are happy to review your full medication list.
Urgent & Acute Eye Care
Many acute eye conditions are better handled at an eye doctor’s office than an urgent care or ER — faster, more appropriate, with the right instruments for the job. We see and treat:
- Conjunctivitis (Pink Eye): Bacterial, viral, and allergic forms each require a different approach. We can determine the type, prescribe when appropriate, and advise on contagion management.
- Foreign Body Removal: Metal fragments, wood splinters, embedded debris — we safely remove most superficial corneal and conjunctival foreign bodies in-office.
- Corneal Abrasions: A scratched cornea needs proper evaluation to prevent infection and promote healing. We assess the injury and initiate treatment the same day.
- Sudden Flashes or Floaters: A shower of new floaters, flashes of light in peripheral vision, or — most urgently — a dark shadow or curtain in your visual field can indicate a retinal tear or detachment. This warrants same-day evaluation. Do not wait for a routine appointment.
- Subconjunctival Hemorrhage: A red patch on the white of the eye. Usually benign and self-resolving, but warrants examination to rule out elevated pressure or underlying causes.
- Eye Infections & Inflammation: Including styes, chalazia, blepharitis flares, iritis, and other anterior segment inflammatory conditions.
Frequently Asked Questions
Is dry eye disease curable?
For most patients, it is a chronic condition requiring ongoing management rather than a single course of treatment. With the right approach, symptoms can be substantially reduced and ocular surface damage can be slowed or halted. Many patients reach a point where their condition is well-controlled and requires only maintenance.
My eye pressure was elevated at my last exam. Does that mean I have glaucoma?
Not necessarily. Elevated IOP is a risk factor, but not a diagnosis. Many people have elevated pressure without developing glaucoma (ocular hypertension), and some develop glaucoma with normal IOP (normal tension glaucoma). A full workup — including OCT, visual field testing, and optic nerve assessment — is needed to make the determination. A single elevated reading warrants monitoring, not necessarily treatment.
Can glaucoma damage be reversed?
Unfortunately, no. Damage to the optic nerve from glaucoma is permanent — which is why early detection and consistent management are so critical. The goal of treatment is to halt or slow further damage, preserving the vision that remains. Never stop prescribed glaucoma drops without discussing it with your doctor first.
I have type 2 diabetes and my vision seems fine. Do I really need an annual dilated exam?
Yes — emphatically. Diabetic retinopathy produces no symptoms in its early stages. By the time your vision is affected, significant and sometimes irreversible damage may have occurred. Annual dilated exams are the standard of care for all patients with diabetes, regardless of blood sugar control or visual symptoms. Early intervention dramatically changes outcomes.
How often do I need to be seen if I have glaucoma?
It depends on the severity and stability of your condition. Patients with early, stable glaucoma may be seen every six months. Those with more advanced disease or IOP that is difficult to control may need more frequent visits. Your doctor will set a monitoring schedule appropriate for your situation — and it should be kept consistently.
What medications should I tell my eye doctor about?
All of them — including over-the-counter supplements and anything you have been on long-term. The ones most commonly associated with ocular effects include hydroxychloroquine, amiodarone, tamoxifen, isotretinoin, oral and inhaled corticosteroids, and some medications for enlarged prostate. When in doubt, bring a complete medication list.
When should new floaters or flashes be treated as an emergency?
If you notice a sudden shower of new floaters, new flashes in your peripheral vision, or — most urgently — a dark shadow or curtain appearing in your visual field, seek same-day eye care. These can be signs of retinal tear or detachment, a medical emergency. A retinal detachment treated promptly can often be repaired with minimal vision loss; one that is delayed cannot.
What is the difference between dry eye and seasonal allergies?
They can feel similar — both cause irritation, redness, and tearing — but the mechanisms differ. Allergic disease typically produces more prominent itching and accompanies other allergic symptoms. Dry eye tends to produce a burning or gritty sensation that worsens later in the day or after prolonged screen use. Many patients have both simultaneously. A proper examination is the most reliable way to distinguish them.
Concerned About an Eye Condition? We’re Here.
Whether you are managing a known diagnosis, monitoring a medication, or dealing with symptoms you have not had answers for — our doctors are equipped to help. Schedule a comprehensive exam at any of our five West Michigan locations, and come prepared to discuss your full health picture. That context matters more than most patients realize.
For urgent symptoms — sudden flashes, floaters, vision loss, or eye injury — please call your nearest Hiemstra Optical location directly for same-day availability.