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26 posts from January 2009

January 29, 2009

Sometimes LASIK Isn't the Answer

I often see patients in my office who come in for a LASIK screening, but are in need of another refractive surgery procedure.  Here is the perfect example: Rich Loboda is  a  61 year old farsighteded patient looking to rid himself of his bifocals.  I explained to Rich that LASIK has the ability to improve his uncorrected distance vision, but would not correct his reading problem.  He would will still need reading glasses, and eventually would need distance glasses again.  Why?  As a person ages, they lose their ability to focus their natural lens. The natural history of farsightedness is a progression.  In 5 years, Rich would be back in bifocals.  

If LASIK is a temporary fix for Rich, what would be a more permanent solution?  Refractive Lens Exchange (RLE) was the answer.  This procedure involves removing the natural lens  and replacing it with an artificial multifocal lens. Rich opted for this surgery.   He is now able to see both distance and near without glasses, and it is a permanent correction!

I received an incredible letter from Rich today and have decided to share it.

Loboda testimonial

BOTTOM LINE:  Not everyone is  an excellent LASIK candidate.  It is important to seek the opinion of a refractive surgeon who offers many surgical options, not just LASIK.  This way the bet refractive surgery can be tailored to your individual needs.

Lisa Lang's LASIK Video Testimonial

Lisa Lang is a realtor ar Burgdorff Realtors in Livingston.  She discusses her experience with LASIK preformed at EyeCare 20/20.

January 27, 2009

Winter Eye Tips




Winter brings many fun activities, but it's important to make sure you stay safe by following these simple winter eye tips brought to you by the  American Academy of Ophthalmology.

Avoid Dry Eyes


The sun is not winter's only eye hazard. Its cool winds and drier air can irritate eyes while indoors and outdoors.




Indoor heat used during winter months tends to rid the air of moisture which can dry out and irritate eyes. Use a humidifier in the bedroom during months with low humidity. This helps moisten dry eyes, especially when exposed to forced air.




Contact lens wearers should limit their outside exposure and use artificial tears frequently. Soft contact lenses are like sponges and need lots of moisture. If they start to dry out, they can become painful and stick to the eye.



Protect Eyes From Harmful UV 


Most people think that it is only necessary to protect the eyes from the sun during the summer. Exposure to UV rays during winter can temporarily harm eyes as well as increase the risk of developing sunlight-related eye disorders, including cataracts.




Wear sunglasses that block 99 to 100 percent of UV light, especially when in the snow. People forget the sun is just as bright when reflected by the snow as it is off the ocean and beach. High quality, UV-blocking sunglasses can prevent and reduce exposure to the wind and cold.


When skiing or snowboarding, wear goggles to protect your eyes. They help protect the skin around the eyes, as well as the eyes themselves. This is especially important since skin on your upper lids is the thinnest and most vulnerable to exposure.


Eyewear with polycarbonate lenses are a must when using snowmobiles, recreational snow vehicles, and even skiing and snowboarding. The goggles will also protect against tree branches and flying ski pole tips.

Applying a good, quality eye cream will also help protect the delicate eye area from the effects of winter. 




Now get on out there and enjoy the winter, because Ground Hog's Day is next week and who knows, spring might be just around the corner!

January 25, 2009

Avastin vs Lucentis: Will The Greed of Genentech and Some Retinal Surgeons Bankrupt Medicare?

Much of the information I present here has been taken from the Patent Docs Blog.

Macular degeneration is the leading case of blindness in patients over the age of 55 in the United States. It affects about 10 million Americans. Lucentis, manufactured by Genentech is the number one approved drug for the treatment of neovascular or "wet" AMD, a condition that if left untreated leads to blindness. Treatment with Lucentis is not a cure,for it merely stabilizes the wet form of macular degeneration, and in many patients prevents the condition from worsening.  This means that it must be administered as a maintenance drug.  At a cost of $2,000/dose and a once-a-month dosing schedule, the cost to treat the half-million "wet" AMD patients in the U.S. would be greater than $10 billion per year!  This is more than the entire Medicare budget ($4.77 billion in 2006) for all of ophthalmology (cataracts, diabetes, glaucoma, and everything else) combined.  In 2004, the entire Medicare Part B budget for all drugs for all medical fields was $12 billion!


Genentech makes another drug used in the treatment of certain cancers, Avastin.  Avastin has been used by many retinal surgeons in an "off label use" to also treat macular degeneration.  The results with Avastin appear comparable to the results with Lucentis.  Avastin is so much cheaper than Lucentis. It is priced at $600/vial for intravenous use, but is injected into the eye at such small doses (0.1cc) that each vial can deliver 30 doses ($20/dose).  

Genentech has opposed the off-label use of Avastin. Genentech has warned ophthalmologists that there is a greater risk of stroke using Avastin.  However, the increased stroke risk was seen at the therapeutic dose for cancer patients, which is 400-fold higher than the dose used to treat AMD.  Recently, Genentech also reported that certain doses of Lucentis used for AMD are also associated with an increased risk of stroke.

I recently received this e-mail from a concerned retinal surgeon, and have decided to publicly share it:

US sales of Lucentis were $236 million for the 4th quarter, a 20% increase over 2007 4th quarter sales of $197 million. Total 200 8 sales were $875 million, a 7% gain over 2007 sales of $815 million.

I was recently at a retina meeting in New York City, and most people I 
talked to use primarily Avastin. Some use Lucentis as their first-line 
anti-VEGF, if their patients have secondary insurance. They generally 
pointed to FDA approval as their rationale. Nobody told me that, in their 
experience, Lucentis has a better safety or efficacy profile. Why have 
Lucentis sales been steadily rising? One might expect that, as our 
experience with Avastin grows and as long as people continue to find Avastin 
safe and efficacious, Lucentis use should decline. I wonder whether a recent 
article in Retina Times offers insight. One practitioner said that he uses 
Lucentis much more now because his office has streamlined reimbursement 
issues. Does the extra $80 income per dose (and the likely need for more 
frequent injections) influence practice patterns? Whatever the motivation, 
our burdening Medicare will ultimately mean that sometime, probably in the 
not-so-distant future, Medicare cuts will result in some patients not having 
access to valuable medical services and some of us not being able to 
maintain viable practices.

So here we have 2 medications made by the same manufacturer, both provide very similar therapeutic results.  One costs $2,000 a dose, the other $20 a dose.  I ask you, what is driving the sales of Lucentis? I will allow you to answer this yourself.

BOTTOM LINE:  When I have a patient with a diagnosis of macular degeneration in need of anti-VEGF therapy, I will not refer them to a retinal surgeon who uses Lucentis as their primary treatment modality.  The buck stops here!

For additional information:  

January 24, 2009

Why Cutting Onions Makes Us Tear

Ah onions, that bulbous wonder! Available in the can, frozen, powered or pickled, but most commonly chopped or sliced. It's the latter form that always makes one a little teary-eyed just thinking about it. Which brings us to our post topic for the day. Why do onions make us tear?

When onions are sliced, cells are broken which release a gas that diffuses through the air. When this gas reaches the eye it reacts with fluid in the eye to form a diluted solution of sulphuric acid. The nerve-endings in the eye then become irritated, making them sting. Tears are then produced by the tear glands, to help flush out the irritants.

So what can you do to help minimize the tearing while slicing an onion? There are a number of theories or suggestions out there, here's what we've found while researching the topic:

  • Freeze the onion for about 10 minutes and then peel. Freezing the onion reduces the activation of the enzymes that cause the irritating gas to be released.
  • Cut the onion in a basin with water or under running water in the sink. The sulfur gas from the onion will react with the water before hitting the eye thereby reducing eye irritation.
  • Why not try a pair of swim goggles or safety glasses?
  • Try a piece of bread in your mouth. The bread should absorb the gas before reaching the eye.
  • If you have contacts wear them. I even found a post on the web from a cooking instructor who had LASIK and afterwards requested non-prescription contacts to use while she taught, she swears it works.
  • Cut near an open flames (ie. candle) The fumes from the flame will react to the gas being released and help minimize irritation.
  • Using a sharp knife blade will limit cell damage and the amount of gas released that cause eye irritation.
  • While slicing the onion, avoid the root area where the concentration of pungency is found.

We also found this video that shows how to cut an onion without tearing:


Cut An Onion Without Crying 

Whatever method you chose, here's hoping your slicing will be tear-free from now on. Have your own suggestions? We'd love to hear what works for you!! 

January 23, 2009

Restaurant Serenade's Nancy & James Laird's LASIK Video Testimonial

Restaurant Serenade, in Chatham NJ, is one of my favorite places to eat.  It's as good as any of the restaurant's in NYC!  It often gets rave reviews.  Its owners is the husband and wife team of James, the Chef, and Nancy, the manager, Laird.

The Laird's had LASIK several years ago.  They were nice enough to talk about their experiences with me in their kitchen.

During Valentine's Day EyeCare 20/20 often gives a gift certificate to Restaurant Serenade to those patients undergoing LASIK.  If you are interested in this program, please ask us about it.

January 22, 2009

A big vision for the future: a billion glasses for those in need


  I was listening to The Take Away this morning on NPR.  Its a great show! Today's Global Health International Segment, "A big vision for the future: a billion glasses for those in need", was very interesting.  You can listen to this segment here.

"In sub-Saharan Africa vision and eye care services are costly and hard to come by. While 60-70% of people in wealthy nations wear corrective lenses, only 5% of people in the developing world wear glasses. Josh Silver, director of research at The Centre for Vision in the Developing World, has been working to make it easier for the world’s most destitute people to get glasses and keep them, even as they get older and their vision changes. He joins us now to talk about his efforts to bring sight to the world."

AdjustGlassesJoshua Silver's glasses are adjusted by pumping liquid into a thin sac in the plastic lenses. He wants the low-cost eyewear to go to poor countries where many can't afford conventional glasses.

According to Silver, there are 3 billion people worldwide in need of eyewear, but an insufficient number of eye care professionals available to treat the needs of these people.  His invention, a self-adjusting eyeglass will allow people to self prescribe their glasses and allow them to see. 

About 10,000 of these glasses have been distributed worldwide, at a cost of about $20 a pair.  His goal is to get the costs down to $1 per pair, and have 1 million distributed by the end of 2010.  From there the skies the limit.



For more information on Joshua Silver and his adjustable glasses project, there are articles in The Guardian and The Seattle Times.

January 21, 2009

twtpoll ::Tweeters who have had LASIK: based on your results, are you glad you had LASIK?

twtpoll ::Tweeters who have had LASIK: based on your results, are you glad you had LASIK?

Posted using ShareThis

January 20, 2009

Sports Agent Blog Interview: Seeing 20/20… LASIK and Sports

I Want to be a Sports Agent

I was recently interviewed by the SportsAgentBlog.com.  The interview was posted today.  This blog is the first site on the Internet devoted to servicing Sports Agents. My interview discussed LASIK and its relationship to sports.  Below is an excerpt from the introduction:

Tiger Woods and LeBron James. They are two of the most recognizable and celebrated athletes on the face of the earth. Both have an almost unparalleled ability to dominate their respective sports, are seen worldwide in countless marketing endeavors, and will both be considered two of the greatest athletes of all time. Another thing they share in common? They have both had LASIK eye surgery done. They’re not alone either. Greg Maddux, Amare Stoudemire, Rip Hamilton, and many others are also taking the time to get the procedure done. With so many big name athletes having their vision corrected, you can see a trend beginning to develop within the professional sports world.

According to a June 2006 Study, approximately 168.5 million residents in the United States, roughly 75% of the population, use some form of vision correction. So chances are you and most of the people you know are wearing glasses or contacts to see properly. With vision being such a critical aspect of every sport, many athletes are considering undergoing the LASIK procedure. Here with us is Cary M. Silverman, M.D., Medical Director of EyeCare 20/20 in New Jersey, to answer some questions about LASIK for us. As a distinguished eye surgeon, Dr. Silverman has been featured in publications such as USA Today, The New York Times, and as a guest ophthalmologist on The Health Network. He has treated a number of professional athletes and is currently correcting the vision of a number of U.S. Winter Olympians prior to the 2010 games in Vancouver.

Rabbi Mark Malek, The Biking Rebbe, LASIK Video Testimonial

Rabbi Mark Malek is a Rabbi in Springfield, NJ.  He is a very avid cyclist, riding over 8,000 miles annually on his recumbent bicycle.  That was not a typo, he really rides 8,000 miles!!  That makes my 2,500 annual miles seem like riding around the neighborhood! He can be seen riding his "bullet" on the streets of Northern, NJ, even in the depths of winter.  He has ridden from Pacific to Atlantic to raise money for his Synagogue.

Rabbi Mark discusses his experience with LASIK surgery at EyeCare 20/20.