The LASIK Blog

My Photo365 Project

This post has nothing to do with eye care...

If you have ever been to my office, you will know that I love photography.  My walls a lined with Black & White photos that I collect and have taken.  Over the past 2 years much of my free time has been devoted to getting a Healthcare MBA from George Washington University.  Because of this, I have not taken any photos in this time.  Well, I am finished with my MBA, and I am in the process of getting back into photography.

My goals over the next few months were to re-learn Photoshop, learn Aperature, and begin taking pictures.  I recently bought a new high end Epson Stylus Pro 4880 printer and Colorbyte ImagePrint software.  I plan on upgrading my Nikon D1X with a Nikon D3x in the next month.

One of my favorite photo blogs is Digital Photography School, put out by Darren Roswe, of Pro Blogger Fame.  His last blog post featured a wonderful idea:  Photo365 Project.  Photo365 involves taking a photo a day over the next year, quite ambitious.  What a great way to get back into photography!  Well, I started yesterday, taking a picture while biking here in NJ with my I-Phone.

I plan on using all cameras at my disposal, my I-Phone, a compact Leica C-Lux 1, a range finder Leica M8, and my hopefully new Nikon D3x.  I will taking clinical pictures here in my office along with things I find interesting.  If you are interested, you can follow my progress on my Flickr site.  Hope you enjoy it, and please, let me know what you think!

Biking With my Shadow 1/365

Do Bifocals Slow Progression of Myopia in Children?

For years, many optometrists have touted the use of bifocals to slow the progression of myopia in children.  This treatment was generally based on anecdotal reports.  A report in this month's Archives of Ophthalmology appears to confirm the usefulness of this treatment modality. 

In Randomized Trial of Effect of Bifocal and Prismatic Bifocal Spectacles on Myopic Progression, Cheng, et al randomly assigned 135  children (73 girls and 62 boys) with myopia of at least 1.00 diopter to receive single-vision lenses (41), +1.50-diopter executive bifocals (48), or +1.50-diopter executive bifocals with a 3-prism diopter base-in prism in the near segment of each lens (46).  The results showed that myopic progression averaged −1.55 diopter  for children who wore single-vision lenses, −0.96 diopter  for those who wore bifocals, and −0.70 diopter for those who wore prismatic bifocals.The treatment effect of bifocals  and prismatic bifocals  was statistically significant.

The authors concede that the treatment effect of bifocal and prismatic bifocal lenses is still small. "Whether or not the effect tapers off will decide clinical significance," they write. "If the treatment effects continued over time, then the treatment could have a significant role in preventing the development of very high pathologic myopia." They conclude that bifocal lenses can moderately slow myopic progression in children with high rates of progression after 24 months. 

Although there is much more to be studied on this topic, we at EyeCare 20/20 will certainly be revisiting this treatment in children with progressive myopia.

LASIK for the Gold's Molly Engstrom and US Women's Hockey Waiting for Olympic Games to Begin!

The Winter Olympics in Vancouver are now less than 3 weeks away.  US Hockey Women's team is primed and ready to go.  They have recently finished their 10 game exhibition series against Team Canada, who are the Gold Medal favorites.  According to the USA Hockey web site:

The results aren’t to Team USA’s liking so far, but there is still the big prize at stake.

The U.S. women’s hockey team is heading into the 2010 Vancouver Olympics carrying a losing streak against its primary foe Canada.

The teams faced off 10 times in the year leading up to the Olympics, with Canada taking seven wins. The most recent four games, all won by Canada, were staged as pre-Olympic exhibitions across North America.

But, Team USA is relishing the role of underdog and looking forward to a strong olympic performance.

Last year, Team USA defenseman, Molly Engstrom joined our LASIK for the Gold team, flying out to New Jersey to EyeCare 20/20 to get her LASIK surgery.  Molly is a 2006 Bronze Medalist who always dreamed of making the US team since she was a kid. Engstrom was also a member of the 2009 and 2005 World Championship teams.

 

Molly recently sent us the following notes, letting us know she is doing well and ready for the competition to begin.  Along with the photo and notes, Molly was kind enough to send me a hockey stick, autographed by the entire Team USA!!

We are all looking forward for a successful olympics for both Molly and her teammates next month.  GO USA!!

 

EyeCare 20/20 Collection Site for Haiti Earthquake Relief

EyeCare 20/20, in conjunction with the Livingston Rotary Clubs, are looking for assistance from our patients and the community to help survivors of the recent tragedy in Haiti.
 
We are asking for the following items that we will forward to the Livingston Rotary Club who will then get them to Haiti through their International Rotary connections:
 

• Baby Food
• Rice
• Pop Top Cans of Beans or Fruit
• Dry Beans
• Dried Meats
• Gently used or new summer clothes, sandals/sneakers, baseball caps, toys/stuffed animals
• First Aid/ Medical Supplies
• Batteries in packages
• Flashlights

 
Items and donations may be dropped at our office located at 46 Eagle Rock Avenue, East Hanover or any of the number of other convenient local drop sites:
 

• Regal Bank  570 W. Mt. Pleasant Avenue, Livingston
• Regal Bank  504 S. Livingston Avenue, Livingston
• PIP Printing  465 W. Mt. Pleasant Avenue, Livingston
• Jan Press Photography  72 S. Livingston Avenue, Livingston
• Investors Savings  371 E. Northfield Avenue, Livingston
• Livingston Chiropractics  65 E. Northfield Road, Suite F, Livingston
• Catridge World  184 S. Livingston Avenue, Livingston
• Law Office of Larry Stempler  704 Passaic Avenue, Caldwell

 
Thank you in advance for your assistance and generosity.
 

Cross-linking Shows Promise For LASIK Complication

OSN Supersite, reporting from the Hawaiian Eye Meeting today an article titled:  Early U.S. cross-linking study results positive for treating keratoconus, ectasia.

Marguerite B. McDonald, MD, presented early results of the prospective, block-randomized clinical trial of 292 eyes with either keratoconus or post-LASIK or post-PRK ectasia. Maximum keratometric value, best corrected visual acuity, uncorrected visual acuity and manifest refraction are being measured in the study.

"The interim conclusions look pretty good," Dr. McDonald said. "It halts the progression of keratoconus and ectasia after LASIK."

"We think it will become the standard of care for the treatment of corneal ectatic disease," Dr. McDonald said.

This is certainly exciting news.  Ectasia is one of the most difficult complications of LASIK surgery. It is a condition in which the cornea assumes a conical shape due to weakness, thinning, and anterior bowing of the corneal surface in patients following LASIK.  These patients may  have a  progressive corneal thinning and bulging.

The key to preventing post LASIK ectasia is proper screening of patients prior to surgery.  Several risk factors exist including:

• Thin corneas
• Irregularities in corneal topography
• Age
• Removing too much corneal tissue

Current treatment regiments for ectasia include:

• Spectacle correction
• Contact lens fitting
• Intacs
• Corneal transplant

Cross-linking of the cornea is a new curative approach to re-increase the mechanical stability of corneal tissue that is progressively decreasing as a result of a corneal disease such as ectasia, keratoconus, or pellucid marginal degeneration. The procedure of corneal cross linking was developed from 1993 until 1997 by Prof. Theo Seiler and Prof. Eberhard Spoerl at the University of Dresden. The first patients were treated in 1998. Today corneal cross-linking is performed in more than 300 centers around the world. In many centers it has the potential to become the standard treatment for ectasia and keratokonus thus preventing the need for corneal transplant.  It is currently undergoing clinical trials here in the US.  I am anxiously awaiting its approval.

In the Pipeline: Toric ICL Shows Promise

There was an interesting article in last month's Ophthalmology titled:  Toric Implantable Collamer Lens for High Myopic Astigmatic Asian Eyes.  This article evaluated the early results of using the Toric Implantable Collamer Lens (TICL) in the treatment of patients with high myopia and astigmatism.  The results were very encouraging: 

• 70.59% of eyes had uncorrected vision of 20/20 or better
• 68.57% of eyes had better uncorrected vision better than the best corrected vision before the surgery

When a patient presents to my office at this time with high myopia and astigmatism, and they are not a candidate for LASIK, their only option is to have an ICL implanted followed by LASEK to correct their residual astigmatism.  The results of these two procedures is excellent.  The TICL is currently unavailable in the US at this time, but once approved, the entire refractive correction may be addressed with one procedure...  Very exciting!

Surgical Innovations: When the Enemy of Good is Better

This week is the annual  Hawaiian Eye Meeting.  This is an excellent eye meeting held at an awesome location.  According to their web site:

At Hawaiian Eye 2010, you can learn from more than 80 of the ophthalmic community’s foremost experts. Speakers will use their clinical experience and subspecialty expertise to provide you with new information and fresh perspectives on the practices and procedures you use most. You’ll be learning directly from the source – the researchers and specialists revolutionizing today’s ophthalmic techniques to improve patient care.

Although I am not attending this year's meeting, I do receive daily updates through Occular Surgery News. Today I received information concerning a lecture titled: Primary posterior capsulotomy a viable option for multifocal IOLs in hyperopes.  According to the article:

Primary posterior capsulotomy with IOL optic buttonholing is a tricky surgery but can have excellent outcomes when implanting multifocal IOLs in hyperopes, a surgeon said here. "I use primary posterior capsulotomy in hyperopes to avoid secondary cataract and decentration," Michael C. Knorz, MD, said in a presentation at Hawaiian Eye 2010.

This is the perfect of taking a straightforward surgical procedure and making it a very difficult procedure with a much higher complication rate!  The doctor in this article is trying to minimize 2 relatively insignificant complications of refractive cataract surgery:

1. After cataract surgery there is a 20% incidence of getting a clouding of a capsule we leave in the eye.  If this occurs, it is easily treated with a simple laser procedure called a YAG capsulotomy.
2. There is a slight chance of decentration of the refractive IOL.  If it is mild, nothing needs to be done as there is no effect on vision.  If the decentration does effect vision, the implant can be repositioned easily through surgery, or the pupil can be moved with a laser treatment.

So, in trying to minimize these 2 easily treated sequalae, this doctor is advocating a procedure of placing a hole in the capsule at the time of surgery and trapping the implant in the hole.  With this new complications can be expected:

• increased retinal detachment
• increased inflammation of the macula (CME)
• increased vitrectomy (removal of the jelly in the back of the eye)
• dislocation of IOL

As a surgeon, we need to be wary of innovations that purport to improve outcomes.  Many times these solutions have inherent risks which far exceed the risks of those procedures they claim to improve upon!

OLYMPIC GAMES - 30 DAYS TO GO: Eyecare 20/20 LASIK Patients Predicted to Win Multiple Medals in Vancouver Winter Games

Team LASIK-FOR-THE-GOLD, is a collection of champion Olympic athletes from across the country who have all had LASIK vision correction surgery performed by me at EyeCare 20/20, here in New Jersey.

 
With exactly one month to go to the start of the Olympic Winter Games, American athletes are scattered around the globe, some are desperately looking to secure their spot on the team, others making the final preparations of a never ending quest to deliver their life's best performance next month in Vancouver, when it matters most.  With the clock ticking, the Lasik-for-the-Gold Winter Olympians appear poised to bring home their share of Olympic hardware.  Here is an update on each of the world class athletes who are my LASIK patients:

 

Katherine Reutter (short track speedskating) - Reutter is now a 17-time world cup medalist who is locked-n-loaded for her Olympic debut.  She will compete in four different events and is considered to be one of Team USA's most likely Olympic medalists. 

Chad Hedrick (speedskating) - Already a gold, silver and bronze medalist from the 2006 Olympics, Hedrick has recently returned to his championship form and earned medals in both of his last two world cup events, including taking the gold medal in Calgary, Canada in December.  Hedrick will square off against fellow American Shani Davis in the 1500 meters at the Olympics in what promises to be one of the must-see showdown events of the Olympics.

Curt Tomasevicz (bobsled) - A pusher behind U.S. driver Steve Holcomb in Team U.S.A.'s number one sled the 'Night Train' (as seen on the Stephan Colbert Show), Tomasevicz and his teammates are on the podium more often than they are off of it.  They are considered the team to beat when the Olympic medals are on the line next month.

Erin Pac (bobsled) - Long since considered 'likely to make the Olympic Team', Pac has recently shown that simply getting to the Olympics isn't good enough.  A world cup bronze medal in Salt Lake City in November turned heads on the international bobsled circuit and marked Pac as someone to keep an eye on in Vancouver.  She currently holds a 5th place ranking in the overall World Cup standings.

Molly Engstrom (hockey) - A bronze medalist at the 2006 Olympics, a World Champion, and a long time member of the U.S. National Team, Engstrom and her teammates are highly likely to do battle with the host Canadian team with gold medals on the line.  In this heated international rivalry, silver doesn't count.

Dan Joye (luge) - Joye, who is part of the doubles luge team of Niccum & Joye, will enter the Games, his second Olympics, as part of the number one ranked U.S. sled.  A recent world cup fourth place finish marked the team's best ever placing - one step up in Vancouver will put Joye on the podium.

Once the Olympics begin, stay tuned for our athletes latest results, or follow them on the LASIK for the Gold blog, twitter feed,  facebook fan page, or YouTube page!

5 Reasons Not to Get LASIK at a Corporate LASIK Center

Corporate LASIK Centers have long touted themselves as the largest providers of LASIK in the US.  I have previously blogged about why I think it is important have your LASIK at a local LASIK provider that provides diversified eye care services.

Here are my top 5 reasons NOT to go to a corporate LASIK Center:

1. Here today, gone tomorrow.  Corporate LASIK centers are large companies.  They are subject to all the external pressures facing corporate America today.  If our banks and auto industry have difficulty in an economic downturn, imagine the problems corporate LASIK centers face with diminishing consumer spending.  A case in point:  TLC, at one time a darling on Wall Street and one of the largest corporate providers, filed for bankruptcy in December.
2. One trick ponies.  Most corporate LASIK centers specialize in LASIK only.  Many times a different procedure, such as ICL or Refractive Lens Exchange (RLE), may provide a superior outcome.  If the corporate center does not do these procedures, they are not offered.  By going to a diversified eye care practice, the correct procedure is paired with a patient's needs.
3. Revolving doors.  The LASIK surgeon at a corporate center is generally an employee.  The turnover at these centers is very high.  One of the centers in my area is on their third surgeon in 5 years.  I know continuity of care is important for my patients.  I still see LASIK patients that I originally treated in 1996, 14 years ago!
4. Commoditization.  Corporate LASIK centers would like you to believe that LASIK is a commodity.  They would like you to believe that LASIK surgery can be done by anyone, and the most important decision a patient can make is to find the best price.  I beg to differ!  Surgical experience and expertise go a long way in achieving superior outcomes.  I always tell patients to shop results, not price.  It is often difficult for a patient to shop outcomes.  The best way to do so is to do your homework.  Ask around and find that practice that has people raving about how well they see, how easy the procedure was, and how well they are treated every time they are seen.  This is who should be doing your LASIK!
5. Lifetime Guarantee?  A great selling point that corporate centers give is the Lifetime Guarantee.  These Lifetime guarantees come with many strings attached.  The Laser Eye Center of Carolina recently blogged about many of these strings:

• The lifetime guarantee only applies to patients within certain parameters. They typically are not available for farsightedness, or for patients with more significant amounts of nearsightedness or astigmatism. The lifetime guarantee only applies if you get an excellent outcome on your initial LASIK procedure.
  
• The guarantee is void if you need an enhancement or “touch-up” procedure. 
• The guarantee only applies if your vision changes to significantly more nearsightedness (worse than 20/40). What if you drift to 20/30 or become farsighted as you age? Sorry, you’re on your own.The guarantee allows only for additional LASIK procedures. Of course, there is a limit to the number of times a LASIK procedure can be performed and the guarantee does not apply to procedures such as conductive keratoplasty which may be a better option for you as you age. 
• The center determines the advisability of further LASIK. This does not allow for the participation of the patient in the decision making. The “lifetime” referred to may be the lifetime of the center. With the current economic downturn, most LASIK-only centers are operating in the red. One large center in Charlotte, NC recently closed its doors. We have seen several patients who were patients of now defunct laser centers who found that their lifetime guarantees were worthless.
• You may be required to undergo yearly exams at an affiliated doctor’s office. Miss one of these mandated exams and your guarantee becomes void. But what difference does it make how often you go in for an exam or where you go? The truth is, unless you have diabetes, glaucoma or some other eye condition, eye exams every two to three years may be sufficient according to the American Academy of Ophthalmology. Such restrictions are an unnecessary burden and expense making it difficult and in some cases, impossible for a patient to meet their obligation under this arrangement.

2010: Lose Those Bifocals! ReSTOR Your Vision!!

Presbyopia is caused when the eye's lens, normally soft and flexible, hardens with age and results in blurred reading vision. The hardening of the lens makes it difficult for the eye to focus on close objects. Presbyopia is part of the normal aging process, typically affecting adults at about 40 years of age. Reading glasses and bifocals are used to treat presbyopia. These assist the eyes in focusing on nearby objects. Since presbyopia affects the lens, LASIK eye surgery, which only treats the cornea, is unable to correct the condition.  Therefore, LASIK patients past their mid 40's still need to wear reading glasses.

For those who do not to wish wear readers, the answer Refractive Lens Exchange (RLE), whereby we remove the eye's natural aging lens and replace it with a multifocal, artificial lens (IOL).  In my opinion, the ReSTOR 3.0 offers the best possible vision at all ranges.  This lens can also be implanted at the time of cataract surgery to markedly reduce the need for glasses after surgery.

Many of our patients at EyeCare 20/20 have questions concerning the use of the ReSTOR.  Because of this, we have produced a very informative video that walks you through the entire process of one of our patient's, Ian Lang, experience with the ReSTOR implant.  We hope that this video answers many of your questions!  If you do decide to have a premium IOL implanted, make sure you have it done by a surgeon with vast refractive and cataract experience.