Eye Education

About the Eye


MCOA Office Locations

We have five office locations to serve you.  To schedule an appointment at one of our clinics please call:




Our goal is to take appropriate steps to attempt to safeguard any medical or other personal information that is provided to us.  The Privacy Rule under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) requires us to:  (i) maintain the privacy of medical information provided to us; (ii) provide notice of our legal duties and privacy practices; and (iii) abide by the terms of our Notice of Privacy Practices currently in effect.


This notice describes the practices of our employees and staff as well as affiliated entities, entities associated with organized health care arrangements, or any other individuals or entities that will be following this notice.  This notice applies to each of these individuals, entities, sites and locations.  In addition, these individuals, entities, sites and locations may share medical information with each other for treatment, payment and health care operation purposes described in this notice.


In the ordinary course of receiving treatment and health care services from us, you will be providing us with personal information such as:

Your name, address, and phone number.
Information relating to your medical history.
Your insurance information and coverage.
Information concerning your doctor, nurse or other medical providers.

In addition, we will gather certain medical information about you and will create a record of the care provided to you.  Some information also may be provided to us by other individuals or organizations that are part of your “circle of care” – such as the referring physician, your other doctors, your health plan, and close friends or family members.


We may use and disclose personal and identifiable health information about you for a variety of purposes.  All of the types of uses and disclosures of information are described below, but not every use or disclosure in a category is listed.

Required Disclosures.  We are required to disclose health information about you to the Secretary of Health and Human Services, upon request, to determine our compliance with HIPAA and to you, in accordance with your right to access and right to receive an accounting of disclosures, as described below.

For Treatment.  We may use health information about you in your treatment.  For example, we may use your medical history, such as any presence or absence of diabetes, to assess the health of your eyes.

For Health Care Operations.  We may use and disclose information about you for the general operation of our business.  For example, we sometimes arrange for auditors or other consultants to review our practices, evaluate our operations, and tell us how to improve our services.  Or, for example, we may use and disclose your health information to review the quality of services provided to you.

Public Policy Uses and Disclosures.  There are a number of public policy reasons why we may disclose information about you which are described below.

We may disclose health information about you when we are required to do so by federal, state, or local law.

We may disclose protected health information about you in connection with certain public health reporting activities.

We may disclose protected health information about you in connection with certain public health reporting activities.  For instance, we may disclose such information to a public health authority authorized to collect or receive PHI for the purpose of preventing or controlling disease, injury or disability, or at the direction of a public health authority, to an official of a foreign government agency that is acting in collaboration with a public health authority.  Public health authorities include state health departments, the Center for Disease Control, the Food and Drug Administration, the Occupational Safety and Health Administration, and the Environmental Protection Agency, to name a few.

We are also permitted to disclose protected health information to a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.  Additionally, we may disclose protected health information to a person subject to the Food and Drug Administration’s power for the following activities:  to report adverse events, product defects or problems, or biological product deviations; to track products; to enable product recalls; repairs or replacements; to conduct post marketing surveillance.  We may also disclose a patient’s health information to a person who may have been exposed to a communicable disease, or to an employer to conduct an evaluation relating to medical surveillance of the workplace, or to evaluate whether an individual has a work-related illness or injury.

We may disclose a patient’s health information where we reasonably believe a patient is a victim of abuse, neglect or domestic violence and the patient authorizes the disclosure, or it is required or authorized by law.

We may disclose health information about you in connection with certain health oversight activities of licensing and other health oversight agencies which are authorized by law.  Health oversight activities include audit, investigation, inspection, licensure or disciplinary actions, and civil, criminal, or administrative proceedings or actions, or any activity necessary for the oversight of 1) the health care system, 2) governmental benefit programs for which health information is relevant to determining beneficiary eligibility, 3) entities subject to governmental regulatory programs for which health information is necessary for determining compliance with program standards, or 4) entities subject to civil rights laws for which health information is necessary for determining compliance.

We may disclose your health information as required by law, including in response to a warrant, subpoena, or other order of a court or administrative hearing body, or to assist law enforcement to identify or locate a suspect, fugitive, material witness or missing person.  Disclosures for law enforcement purposes also permit us to make disclosures about victims of crimes and the death of an individual, among others.

We may release a patient’s health information (1) to a coroner or medical examiner to identify a deceased person or determine the cause of death, and (2) to funeral directors.  We also may release your health information to organ procurement organizations, transplant centers, and eye or tissue banks, if you are an organ donor.

We may release your health information to workers’ compensation or similar programs, which provide benefits for work-related injuries or illnesses, without regard to fault.

Health information about you may also be disclosed when necessary to prevent a serious threat to your health and safety or the health and safety of others.

We may use or disclose certain health information about your condition and treatment for research purposes where an Institutional Review Board or a similar body referred to as a Privacy Board determines that your privacy interests will be adequately protected in the study.  We may also use and disclose your health information to prepare or analyze a research protocol and for other research purposes.

If you are a member of the Armed Forces, we may release health information about you for activities deemed necessary by military command authorities.  We also may release health information about foreign military personnel to their appropriate foreign military authority.

We may disclose your protected health information for legal or administrative proceedings that involve you.  We may release such information upon order of a court or administrative tribunal.  We may also release protected health information in the absence of such an order and in response to a discovery or other lawful request, if efforts have been made to notify you or secure a protective order.

If you are an inmate, we may release protected health information about you to a correctional institution where you are incarcerated or to law enforcement officials in certain situations, such as where the information is necessary for your treatment, health or safety, or the health or safety of others.

Finally, we may disclose protected health information for national security and intelligence activities, and for the provision of protective services to the President of the United Sates and other officials or foreign heads of state.

Our Business Associates.  We sometimes work with outside individuals and businesses that help us operate our business successfully.  We may disclose your health information to these business associates so that they can perform the tasks that we hire them to do.  Our business associates must promise that they will respect the confidentiality of your personal and identifiable health information.

Disclosures to Persons Assisting in Your Care or Payment for Your Care.  We may disclose information to individuals involved in your care or in the payment for your care.  This includes people and organizations that are part of your “circle of care” – such as your spouse, your other doctors, or an aide who may be providing services to you.  We may also use and disclose health information about a patient for disaster relief efforts, and to notify persons responsible for a patient’s care about a patient’s location, general condition, or death.  Generally, we will obtain your verbal agreement before using or disclosing health information in this way.  However, under certain circumstances, such as in an emergency situation, we may make these uses and disclosures without your agreement.

[To the extent another state or federal law restricts the ability of the practice to use or disclose protected health information as discussed above, the descriptions above must reflect the more stringent law.]

Appointment reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment or that you should schedule an appointment.

Treatment alternatives.  We may use and disclose medical information in order to tell you about or recommend possible treatment options, alternatives, or health-related services that may be of interest to you.


We are required to obtain written authorization from you for any other uses and disclosures of medical information other than those described above.  If you provide us with such permission, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose personal information about you for the reasons covered by your written authorization, except to the extent we have already relied on your original permission.


You have the right to ask for restrictions on the ways we use and disclose your health information for treatment, payment and health care operation purposes.  You may request that we limit our disclosures to persons assisting your care or payment for your care.  We will consider your request, but we are not required to accept it.

You have the right to request that you receive communications containing your protected health information from us by alternative means or at alternative locations.  For example, you may ask that we only contact you at home or by mail.

Except under certain circumstances, you have the right to inspect and copy medical, billing and other records used to make decisions about you.  If you ask for copies of this information, we may charge you a fee for copying and mailing.

If you believe that information in your records is incorrect or incomplete, you have the right to ask us to correct the existing information or add missing information.  Under certain circumstances, we may deny your request, such as when the information is accurate and complete.

You have a right to receive a list of certain instances when we have used or disclosed your medical information.  We are not required to include the list uses and disclosures for your treatment, payment for services furnished to you, our health care operations, disclosures to you, disclosures you give us authorization to make, and uses and disclosures before April 14, 2003, among others.  If you ask for this information from us more than once every twelve months, we may charge you a fee.

You have a right to a copy of this notice in paper form.  You may ask for a copy at any time.

You may also obtain a copy of this form at our web site, http://www.mcoaicare.com.

To exercise any of your rights, please contact us in writing, attention:  Privacy Officer, Medical Center Ophthalmology Associates, 9157 Huebner Rd., San Antonio, TX 78240.  When making a request for amendment, you must state a reason for making the request.


We reserve the right to make changes to this notice at any time.  We reserve the right to make the revised notice effective for personal health information we have about you as well as any information we receive in the future.  In the event there is a material change to this notice, the revised notice will be posted.  In addition, you may request a copy of the revised notice at any time.


If you have any complaints concerning our privacy practices, you may contact the Secretary of the Department of Health and Human Services at 200 Independence Avenue S.W., Room 509F, HHH Building, Washington, D.C. 20201 (e-mail:  ).  You may also contact:  Privacy Officer, Medical Center Ophthalmology Associates, 9157 Huebner Rd., San Antonio, TX 78240.


To obtain more information concerning this notice, you may contact our Privacy Officer at 9157 Huebner Rd., San Antonio, TX 78240.

This notice is effective as of April 13, 2003.

New Patient Registration Online.

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  • By providing your new patient registration online ahead of your appointment, we will be better prepared with your information neatly printed in our charts.

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HIPAA Notice
( Health Insurance Portability and Accountability Act )

Age-Related Macular Degeneration

Darren Bell, M.D.

Age-related macular degeneration (AMD) has been in the news a lot recently, primarily because of newly developed pharmacologic therapies.  While certainly welcome news for patients, unless you or someone you know has been diagnosed with AMD, you may wonder why it has received so much attention.

What is Paragon CRT ® ?

Paragon CRT is a specially designed oxygen permeable therapeutic contact lens used in Corneal Refractive Therapy. 

What is Corneal Refractive Therapy?
Corneal Refractive Therapy is a sophisticated non-surgical process that temporarily reshapes the cornea while you sleep.  You remove the lenses when you awake and are able to go throughout the day without any other vision correction.

How new is Paragon CRT?
The idea of contact lens corneal reshaping is not a new concept.  Previous corneal reshaping designs were only as successful as technology allowed.  Paragon Vision Sciences has taken the recent advancements in computerized corneal mapping, computerized manufacturing, and oxygen permeable contact lens materials and produced a therapeutic contact lens design that is like no other.  This has allowed Paragon CRT to become the one corneal reshaping modality that truly stands out and the first to earn FDA approval for nighttime Corneal Refractive Therapy. 

Is Corneal Refractive Therapy Permanent?
No. It’s temporary.  If you stop wearing the lenses regularly while you sleep, your vision will return to its original state in as little as 72 hours.

Can everyone wear Paragon CRT?
Paragon CRT treats nearsightedness (myopia up to –6.00 diopters) with or without minor astigmatism (up to –1.75 diopters). And because there are no age restrictions on Paragon CRT, it may be the perfect option for any member of the family including active adolescents.  The doctor will provide more information about Paragon CRT and if it is right for you.

Paragon CRT therapeutic contact lenses are not yet available in bifocal prescriptions for presbyopia (which requires reading glasses or bifocals).  At the doctor’s discretion you may be fitted in a monovision mode (one eye corrected for near vision and one corrected for distance vision).  You might still need reading glasses.  However, since there are variations in patient physiology and visual needs, the decision for Paragon CRT, at any age , can only be made after a thorough eye exam and the recommendations of an eye care professional.  At this time, hyperopia (farsightedness) is not correctable with Paragon CRT.

How long does it take to reach good vision?
Most patients have rapid improvement in the first few days of treatment and achieve nearly their optimum vision in 10 to 14 days.

What do I do to see adequately in the period of time between when I start Corneal Refractive Therapy with Paragon CRT and when I achieve full treatment?
It’s important to understand that for a time after you have begun treatment, but before sufficient treatment is realized, your old glasses or contacts will no longer be the appropriate prescription.  It may involve re-insertion of your Paragon CRT lenses for part of the day or some use of temporary soft lenses in different prescriptions. The doctor will discuss your options for visual correction during that period of time.

Are there any risks involved with wearing Paragon CRT?
There is a small risk involved when any contact lens is worn.  It is not expected that the Paragon CRT lenses for contact lens Corneal Refractive Therapy will provide a risk that is greater than other contact lenses.  There were no serious adverse events reported in the Paragon CRT FDA clinical study.

Can I see with my Paragon CRT lenses in?
Yes.  One of the great features of the Paragon CRT lens is that if you get up in the middle of the night, you will be able to see perfectly.  You will enjoy great vision with your Paragon CRT lenses on or off.

How often will I have to replace my Paragon CRT lenses?
Generally speaking the Paragon CRT lenses will have to be replaced annually.  However, depending on factors such as protein buildup, how well the lenses are taken care of, etc., the lenses may have to be replaced more or less frequently.

How do I care for my Paragon CRT lenses?
Your lenses should be chemically disinfected after every use (not heat).  We will instruct you about which care system is best for you. Paragon Vision Sciences exclusively recommend Unique-ph ® Multi-purpose solution.

Specialized Diagnostic Services

Diagnostic services and laser treatment are provided for patients. The retina is the transparent tissue that lines the back inside wall of the eye. Early detection and treatment of retinal problems can often prevent further deterioration or loss of vision.


Age-Related Farsightedness
Regardless of eye condition in your youth, your eyes will most likely begin to change as you reach your mid-40s and beyond.

Eye Injury Prevention

More than one million people suffer from eye injuries each year in the United States. Ninety percent of these injuries could have been prevented if the individual had been wearing appropriate protective eyewear.

Approximately 20.5 million Americans age 40 and older have cataracts.

Cataracts are the clouding of the eye’s clear lens; like a window that is “fogged” with steam. When the lens becomes cloudy, light rays cannot pass through it easily and vision becomes blurry. 

Children’s Eye Health & Safety

Vision problems affect one in twenty preschoolers and one in four school-aged children.

80 percent of the world’s blindness is avoidable.

World Blindness Awareness
Every five seconds one person in the world goes blind. Below are the five leading causes of blindness and vision loss throughout the world.

Diabetic Eye Disease Awareness

Approximately 10.3 million Americans have diabetes. Over half of these individuals are at risk for vision loss and other health problems because they don’t know they have the disease.

Glaucoma is the second most common cause of blindness in the U.S.

Approximately 2.2 million Americans age forty and older have glaucoma and half are at risk of going blind because they do not know they have the disease. You could be one of them.

When Should Your Child Have an Eye Exam?


Great news for people with cataracts

Great news for people with cataracts: New lens implant technologies allow unprecedented flexibility of vision and freedom from glasses.
Scott A. Thomas, M.D., July 2007

Sports Eye Health

From major league stadiums to small-town courts, America’s favorite pastimes make great memories for many. But for more than 40,000 athletes, those memories are ruined by eye injuries, the vast majority of which were preventable.

Facts on Firework Eye Safety

Fireworks are exciting, fun and spectacular, but decades of experience have taught us that they are dangerous and should be left to professional firework handlers.

Optical Center

MCOA Optical

Your eyewear should fit your lifestyle. At Medical Center Ophthalmology Associates you’ll get the eyewear you need for the way you live, work and play!


Contact Lens Department

Tired of Wearing Eyeglasses?

Did you know that the MCOA Contact Lens Department can assist you in seeing near and far with contact lenses and eliminate the need to wear eyeglasses? Rigid Gas Permeable (RGP) bifocal, soft bifocal contact lenses and all brands of disposable soft lenses are available and reasonably priced.

Vision Correction While You Sleep
Click here to see Frequently Asked Questions


What is LASIK?
LASIK is the acronym for Laser-Assisted in Situ Keratomileusis.
LASIK is a surgical procedure that uses the excimer laser to help correct nearsightedness and astigmatism. Introduced in 1988, this procedure creates a thin flap of corneal tissue which is lifted back to allow the laser beam to sculpt the inner tissue to just the right amount of correction. When the procedure is finished, the flap is gently replaced over the treated area where it adheres without any sutures. The cornea’s new shape allows the light images to focus more clearly on the retina.

What are the risks with LASIK?
There are risks with any surgical procedure. Although complications with LASIK are rare, you need to be aware of them. Potential problems include complications with the corneal flap, infection, removing too much or too little tissue with the laser beam, the need for reading glasses, microscopic surface irregularities, halo effect, vision gradually returning to the way it was before LASIK, inability to wear contact lenses, and other remote risks.

Can anyone have LASIK performed?
If you would like to reduce your dependency on corrective lenses and you are nearsighted or have astigmatism and are 18 or older with a stable prescription and healthy eyes, you may be able to benefit from LASIK.

How long will I be off work?
The amount of time you are off work often depends on how important good vision is to performing your tasks, but most people miss only 1 or 2 days. If scheduling permits, we are able to do your procedure on Friday and you can return to work on Monday.

Will I have to wear glasses or contact lenses after surgery?
LASIK is not a miracle procedure. It does not promise perfect vision or that everyone will be totally free of corrective lenses. The more correction you require, the greater the chance that you may still need glasses or contacts for certain activities.

If I don’t get full correction, can I be retreated?
Correction may be fine-tuned with retreatment, known as enhancement, and is generally performed within the first three months. With an enhancement, the flap is simply lifted back to allow the laser beam to remove a little more tissue. Then the flap is gently smoothed back into place again. Although retreatment may further improve your ability to see, perfect vision is still impossible to guarantee.

Do I need to use eye drops after the procedure?
You will use medicated eye drops for 1 week after your treatment, and artificial tears are recommended up to 1 month.

Are my eyes patched after surgery?
Your eyes are not patched after LASIK, but you will be given clear plastic eye shields to wear during the first night.

Will I feel any pain or discomfort during LASIK?
There is no pain during the actual treatment since eye drops numb your eyes. If needed, you may also be given a mild sedative. You will feel some pressure when a tiny instrument is placed on your eye and your vision may dim for a few seconds while the flap is being created, but you should not feel any pain. After the procedure, some people experience mild irritation, light sensitivity and watery eyes for a few days.

How long does the procedure take?
Since both eyes are usually treated during the same appointment, you are in the LASIK suite for approximately 15 minutes. However, the procedure takes less than 5 minutes for each eye.

Do you treat both eyes on the same day or separately?
Generally, both eyes are treated the same day.

How long have MCOA surgeons been doing LASIK?
Surgeons at Medical Center Ophthalmology have been performing LASIK since early 1998, soon after the excimer laser was approved for use in the USA.

Has anyone ever gone blind?
In the many thousands of LASIK cases performed worldwide, we know of no recorded incidence of anyone losing their eyesight due to this procedure.

What are the long term effects of LASIK?
Since LASIK is a relatively new procedure, no one knows with absolute certainty what the long term effects are. However, since LASIK was first introduced, clinical studies have been unable to show any negative effects on the eye. If a problem does develop, it will most likely occur within the first few months after the procedure, not years later.

Macular Degeneration Terms

Amsler Grid-Graph paper-like grid used in detecting central visual field distortions or defects.

Angiogenesis (Choroidal)- The growth of abnormal blood vessels.

Atrophic- Derived from atrophy. Refers to cells, Structures or organs that have wasted away and have lost their normal function.

Atrophy- Refers to cells, structures or organs that have wasted away and have lost their normal function.

Brunch’s membrane- Innermost layer of the choroid, lying directly under retinal pigment epithelium. When damaged by disease or aging is responsible for many bleeding disorders in the macular area.

Carotenoid- Any member of a group of red, orange or yellow pigmented lipids found in carrots, sweet potatoes, green leaves and some animal tissues.

Choroid- The layer of blood vessels and connective tissue between the sclera (white of the eye) and retina.

Drusen- Tiny, white, hyaline (clear, glassy like) deposits lying beneath the retinal pigment (RPE).

Endothelial- The lining of blood and lymph vessels.

Fibrovascular- Both fibrous and vascular.

Fluorescein Angiogram- Medical exam used for evaluating retinal, choroidal, and iris blood vessels; fluorescein dye is injected into an arm vein, then sequential photographs are taken of the eye as the dye circulates.

Indoyacine Green (ICG)- A newer dye, indocyanine green (ICG) used in an effective testing procedure for AMD called a fluorescein angiogram. ICG is a larger and more readily protein-bound molecule than fluorescein. Because of its light absorption properties, ICG dye permits better visualization.

Macula- Small, specialized central area of the retina, surrounding the fovea, which is responsible for acute central vision.

Metamorhopsia- Objects appear distorted in shape; usually caused by macular disturbances that disrupt the normal retinal position.

Neovascularization (Choroidal)- Abnormal formation of new blood vessels usually on or under the retina, usually seen in diabetic retinopathy, blockages of central retinal vision and macular degeneration.

Ophthalmoscopic Examination-Process of using a device for examination of the interior of the eye, especially the fundus.

Photocoagulation- Surgical procedure involving the application of intense light to burn or destroy selected intraocular structures such as abnormal blood vessels and tumors.

Photoreceptor- A nerve end- organ or receptor sensitive to light.

Retina- The innermost of the three tunics (coats) of the eyeball, surrounding the vitreous body and continuous posteriorly with the optic nerve.

Retinal Pigment Epithelium (RPE)- Pigment cell layer just outside the retina that nourishes retinal visual cells; is firmly attached to underlying choroid and overlying retinal visual cells- composed of one layer of cells that are densely packed with pigment granules.

Retinotomy- Removal of portion of the retina.

Thrombus- A solid mass formed by the condtituents of blood: a clot

Vitrectromy- Surgical procedure involving the removal of vitreous, blood and/or membranes from the eye; usually accomplished by entering through the pars plana with a needle-like rotary cutter that has fluid injection and suction capabilities.

Macular Degeneration Vision Loss

Vision Deterioration in Dry AMD

Vision loss in dry AMD is caused by atrophy or weakening of the retinal pigment epithelium (RPE) layer just outside the retina and the overlying photoreceptor cells. Vision loss with dry AMD is usually slow and gradual. A patient may begin to notice blank areas in their central vision. Over time, dry AMD can cause a large loss of detail vision; however, vision loss is generally not as severe compared to the wet form.

Development of Wet AMD

As previously discussed, dry AMD will often begin to convert to wet AMD, with the appearance of abnormal choroidal blood vessels - angiogenesis. The reason why angiogenesis occurs is unknown, however, it is believed that there is a link between angiogenesis and damage to Bruch’s membrane, which lies directly under the RPE, caused by the deposit of drusen. The drusen allows an angiogenic stimulant to promote the growth of underlying choroidal blood vessels into the subretinal space and retina. These tufts of blood vessels are fragile and have a propensity to leak and bleed, eventually forming scar tissue and resulting in irreversible vision loss.

Diagnosis of Macular Degeneration

Official diagnosis of AMD must be made by an ophthalmologist or optometrist. Early detection of AMD is important as treatments such as laser photocoagulation and Visudyne™ (a photodynamic therapy) may halt or slow progression of the disease only if detected at an early state. Unfortunately, it will usually not reverse existing retinal damage. Therefore, regular eye exams are crucial to detecting AMD in its early stages.

According to the American Academy of Ophthalmology (AAO), “asymptomatic individuals 40 to 64 years of age who have had a previously comprehensive examination, the recommended interval for interim evaluations is two to four years. For the age group of 65 or older, the AAO recommends an examination every one to two years, even in the absence of symptoms.” (AAO Policy Statement, September 15, 1990)

Methods of Detection

Decreased central visual acuity - the ability to see at various distances - is the classic symptom of age-related macular degeneration. The decreased visual acuity or image distortion is often termed metamorphopsia. Metamorphopsia can easily be detected with an Amsler Grid.

Since many patients with dry macular degeneration have no symptoms, an ophthalmoscopic examination is conducted. Ophthalmoscopic examination allows for detection of both early and late signs of macular degeneration.

Angiographic Diagnosis - The fluorescein angiogram is fundamental in diagnosis and treatment of choroidal neovascularization or the abnormal growth of blood vessels on or under the retina. It allows the retinal specialist to pinpoint the location and extent of neovascularization. It can also assist in guiding laser photocoagulation if indicated. However, only about 13% of angiograms show a treatable localized lesion (drusen) or classic choroidal neovascularization. The other 87% show diffused, poorly defined lesions that are not appropriate for laser photocoagulation or Visudyne therapy. These lesions are called occult choroidal neovascularization.

In this test, a special dye is injected intravenously and pictures are taken as the dye passes through the vessels in the retina. These photos identify leaking blood vessels or choroidal neovascularization. Improvements in this testing procedure have recently proven to be more effective at identifying poorly defined or occult choroidal neovascularization with a newer dye, indocyanine green (ICG) that permits better visualization.

Amsler Grid

The Amsler Grid is a chart that may be helpful in revealing signs of wet age-related macular degeneration (AMD); however, it is not a substitute for regularly scheduled eye exams/tests. The grid looks like a piece of paper with dark lines that form a square grid with one dot in the middle. To administer the test, hold the Amsler Grid at eye level at a comfortable reading distance. If you wear any type of reading lenses, wear them during the test. Cover one eye at a time, and focus on the center dot. If you notice any of the potential signs of AMD like wavy, broken or distorted lines or blurred or missing areas of vision, you should contact your eye care provider immediately. Remember that the Amsler Grid is not a substitute for regularly scheduled eye exams/tests, which should take place at least once every two years, especially after the age of 40.

To test yourself:

Print a copy of the Amsler Grid, and hang grid with the center dot at eye level on a bare wall in a well-lighted room. Wearing the glasses or contacts you normally wear for reading, stand 13 inches/33 cm from the wall. Cover one eye with your hand, then focus on the center dot with uncovered eye. You should see all four corners of the grid. Repeat with other eye. If you see wavy or fuzzy lines, you may be displaying symptoms of AMD. Click on the grid below for a printable version.

Please note that some people with AMD may not see distortions on the Amsler grid. Any noticeable change in your vision should be reported to your eye doctor immediately. 

Types of Macular Degeneration

Age-Related Macular degeneration occurs as two distinct types, dry and wet. Most AMD starts with the dry form which may or may not develop into the wet form.

Dry AMD may also be called atrophic or non-neovascular macular degeneration. Dry AMD is the more common and milder form of AMD, accounting for 85% to 90% of all AMD. The key identifier for dry AMD are small, round, white-yellow lesions in the macula called drusen. Vision loss associated with dry AMD is far less dramatic than in the case of wet AMD. There is currently not a treatment available for dry AMD.

Wet AMD is less prevalent than the dry form representing 10% to 15% of AMD cases. The term wet denotes choroidal neovascularization (CNV), the development of abnormal blood vessels beneath the retinal pigment epithelium (RPE) layer of the retina. The potential for significant vision loss is much greater. Wet AMD is characterized by the development of abnormal choroidal angiogenesis which causes severe, and potentially rapid, visual deterioration. Laser treatment may be recommended if neovascularization exists.

Incidence and Risks

Incidence: In the US, it is estimated that between the ages of 43 to 86, approximately 1.2% of this population are affected by wet AMD, as opposed to 15.6% for dry AMD. (Source: Beaver Dam Eye Study). Based on this statistic, over 200,000 new cases of wet AMD, occur each year in North America.

Risks: Many studies have been done to identify risk factors for AMD.
Age: Wet AMD usually shows itself to individuals over the age of 50
Genetics: A hereditary link has been identified, and as such, the American Academy of Ophthalmology (AAO) recommends patients who have blood relatives with AMD undergo a retinal exam every two years.
Race/Gender: In general, the incidence of AMD is most prevalent in white women (over age 60).
Smoking: Studies have also shown definite associations between cigarette smoking and increased risk of both wet and dry macular degeneration. Hypertension: Furthermore, patients with dry AMD, who are on antihypertensive drug therapy coupled with high serum cholesterol levels, and low serum carotenoid are at a greater risk for developing choroidal neovascularization
Menopause: postmenopausal women who do not undergo estrogen therapy are also at a greater risk of developing neovascularization.
The role of vitamins, minerals, and antioxidants in the prevention of macular degeneration has been the source of controversy and conflicting information. High serum levels of vitamins E, A, and C, as well as zinc, may be beneficial, but currently their efficacy is unproven. The National Eye Institute is currently sponsoring a study called AREDS (The Age Related Eye Disease Study). The study is testing the use of antioxidants and zinc on the progression of AMD. The study should provide a more definitive answer regarding the use of these supplements.

Macular Degeneration

Age-Related Macular Degeneration: Age-related macular degeneration (AMD) is a disease that affects your central vision. It is a common cause of vision loss among people over age of 60. Because only the center of your vision is usually affected, people rarely go blind from the disease. However, AMD can sometimes make it difficult to read, drive, or perform other daily activities that require fine, central vision.

  • Types of Macular Degeneration
  • Diagnosis of Macular Degeneration
  • Macular Degeneration Vision Loss
  • Glossary of Terms

    Specialty Eye Surgery

    Medical and surgical management is available for patients.  This care includes the cornea or clear window of the eye, the conjunctiva or lining inside the eyelids, and the sclera or white covering of the eye. 

    Cataract Surgery

    A cataract is a cloudiness that develops in the normally clear lens of the eye. The lens, about the size of an aspirin, is the transparent fine focusing part of the eye located behind the pupil. It is comprised of a strong, transparent outer covering or capsule filled with a clear gel material. When the gel becomes cloudy, the incoming light rays are distorted or blocked before reaching the retina at the back of the eye. As the cataract develops, vision is increasingly reduced. Your family optometrist will usually discover developing cataracts in the course of routine eye exams. If you have cataracts that are causing visual difficulties, your doctor will usually recommend surgery, the only known cure for cataracts.

    Laser Vision Correction

    The eximer laser was FDA approved in 1995 and has since then treated millions of people to eliminate or reduce their dependence on glasses and contact lenses. Whether you suffer from nearsightedness, farsightedness, or astigmatism, we may be able to provide you with the potential to experience better vision than is possible with glasses or contact lenses.

    NASA Approves Advanced LASIK For Use On Astronauts:


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    Online Patient Surveys

    Patient Survey
    Medical Center Ophthalmology Associates is dedicated to offering the highest quality of patient care. For this reason, we ask that you take a moment to complete this survey so that we can continue to strive for excellence in patient satisfaction.

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    The doctor taking time to answer your questions

    The doctor adequately explaining treatment options

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    Glaucoma Care

    Complete diagnostic, medical and surgical care is available for glaucoma patients. This specialty treats the condition of increased fluid pressure within the eye. If untreated, abnormally high eye pressure can damage the optic nerve leading to permanent loss of vision.

    Family Eye Care

    MCOA’s many physicians and staff are here for you and your family to assist with all your vision needs and emergencies.

    Diabetic Eye Care

    Diabetes affects over 14 million Americans. More than 8,000 Americans will become blind from diabetic retinopathy. Visual loss is a late symptom of diabetic retinopathy. There’s a lot you can do to take charge and prevent such problems. A recent study shows that keeping your blood glucose closer to normal can prevent or delay diabetic retinopathy.

    Northwest Clinic (Main)

    9157 Huebner Rd., San Antonio, Texas 78240

    Stone Oak Clinic

    109 Gallery Circle, Suite 139, San Antonio, Texas 78258

    Northeast Clinic

    11900 Crownpoint Drive, Suite 140, San Antonio, Texas 78233

    Downtown Clinic

    315 N. San Saba, Suite 970, San Antonio, Texas 78207

    Del Rio Clinic

    608 Bedell, Suite A, Del Rio,Tx 78440 • 830-775-7271

    Steven J. Fisher, M.D.

    General Ophthalmology
    Cataract Surgery
    Refractive Surgery

    Richard M. Evans, M.D.

    General Ophthalmology
    Cataract Surgery
    Refractive Surgery

    Michael A. Singer, M.D.

    Retina, Macular Degeneration & Diabetic Eye Specialist

    Jason D. Burns, M.D.

    General Ophthalmology
    Cataract Surgery
    Refractive Surgery

    Jeffrey H. Cohen, M.D., F.A.C.S.

    Pediatric Ophthalmology
    Adult Strabismus

    Jorge A. De La Chapa, D.O.

    General Ophthalmology
    Cataract Surgery
    Refractive Surgery

    Darren J. Bell, M.D.

    Retina, Macular Degeneration & Diabetic Eye Specialist

    Scott A. Thomas, M.D.

    General Ophthalmology
    Cataract Surgery
    Refractive Surgery

    Ann-Marie Mora, O.D.

    Therapeutic Optometrist
    Optometric Glaucoma Specialist

    Michael A. Orozco, O.D.

    Therapeutic Optometrist
    Optometric Glaucoma Specialist

    Shayesteh M. Izaddoost, O.D.

    Therapeutic Optometrist
    Optometric Glaucoma Specialist

    Payment Options

    Vision Correction is an excellent investment in an individual’s personal well being. Because of this, we believe financial considerations should not be an obstacle to benefiting from the lifetime of advantages that LASIK, or any other vision corrections, can provide. Being sensitive to the fact that different patients have different needs, we provide the following payment options:

    • Low monthly payment plans
    • Cash or Check
    • Credit Cards
    • Flex Account

    24 Months Same As Cash!!


    Capital One Healthcare finance
    Vision Fee Plan is a flexible monthly payment option offered through MCOA and specifically designed for refractive surgery with payments as low as $57 (one eye) or $74 (both eyes) per month.
    • No Down Payment
    • Low Monthly Payments
    • Low, Fixed Rates from 5.9% - 12.9%
    • No Prepayment Penalty

    You may apply quickly and securly online. Click the logo below to begin:


    We accept all major credit cards, including:

    • Visa
    • MasterCard
    • Discover
    • American Express

    Although a majority of insurance plans still do not cover laser vision correction, always check with your Benefits Coordinator regarding your individual coverage. Some plans do offer discounts.

    Your company may offer a medical spending account that allows you to set aside dollars to pay for your medical expenses. Please contact your employer for more details.

    Optical Fun



    More Optical Illusions:
    Cool, Amazing Optical Illusions!

    Clinical Trials

    MCOA is dedicated to advancing the field of Ophthalmology through research, clinical studies and the development of new instruments and techniques. We are engaged in multiple clinical research trials of new therapies for various ophthalmological diseases. You will find information about some of these studies below.

    1.  ClinicalTrials.gov

    2.  ClinicalTrials.gov

    News and Seminars

    Currently, there are no seminars scheduled. We do offer free consultations for Laser Vision Correction. This consultation allows us to perform the correct testing and helps the doctor to determine the best option available for you and your lifestyle. Our doctors are present at each and every appointment, before, during and after surgery, to ensure that all of your questions and concerns have been answered.

    To take your first step towards clearer vision, fill out the information below or call 210-697-2020.

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    MCOA San Antonio

    Northwest Clinic:
    9157 Huebner Rd.
    San Antonio, Texas 78240

    Northeast Clinic:
    11900 Crownpoint Drive, Suite 140
    San Antonio, Texas 78233

    Downtown Clinic:
    315 N. San Saba, Suite 970
    San Antonio, Texas 78207

    Stone Oak Clinic:
    109 Gallery Circle, Suite 139
    San Antonio, Texas 78258

    Del Rio Clinic:
    608 Bedell, Suite A
    Del Rio,Tx 78440

    Design by Lynn-Douglas Media

    Medical Center Ophthalmology Associates

    Welcome to Medical Center Ophthalmology Associates, San Antonio's largest private group of eye care specialists.

    From the very beginning of life-seeing premature infants in the NICU, to performing donor corneal transplants and all eye care needs in between-MCOA provides you and your family with caring physicians and staff using the latest technology to help diagnose and treat your condition.

    Specializing In Your Eyes...
    Focusing On Your Needs

    • Specialized Retina Care

    • Pediatric Eye Care

    • Dry Eye Treatment

    • Optical Shop

    • Contact Lens Fittings

    • Orthokeratology (Ortho-K)

    • ReZoom ReSTOR Crystalens
    • Macular Degeneration, Treatment & Surgery

    • Glaucoma Treatment & Surgery

    • Diabetic Eye Care, Treatment & Surgery

    • Customized Cataract Surgery - Presbyopia Correction Available