The LASIK Blog

The LASIK Blog is Moving to Our New Web Site!

I started The LASIK Blog over 3 years ago as a seperate entity from my office's main web site, EyeCare2020.com.  I have been very happy by the response, you, my readers have given it.  Thank you.

I am please to announce that we have launched our new and improved web site last night!  Although I got many complements concerning the old site, I had many issues with it.  It was created with old technology, it was static and difficult to update, and it was not able to keep up with the rapidly changing technology of both ophthalmology and social media.  The new site will be a constantly evolving site; new features will be constantly added to the site as the world of ophtalmology changes.  In addition, The LASIK Blog will be moving directly onto the site!

I hope you all will continue to read my posts, and drop me a note if there is something you want to talk about!!

Piggy BackToric IOL Improves from -18.0 to 20/20 Witout Glasses

Christine was in my office today 1 week after her cataract surgery on her second eye.  She is already seeing 20/20 without glasses!  What makes this story unique is that she was an extremely nearsighted and astigmatic patient with cataracts.  Before surgery she had a correction of -18 myopia and -2 of astigmatism.  Her best correctied vision was a blurry 20/50.

After discussing cataract surgery, we decided that Christine's best chance of excellent vision was with a toric IOL.  There was only 1 problem, because of the amount of nearsightedness she had there was no toric IOL in her power.  The surgical plan I came up with was to piggy back to implants, one toric (to correct her astigmatism and most of her nearsightedness) and the other spherical (to correct the residual nearsightedness.

The results were better than expected, 20/20 vision 1 week after surgery!  Christine was kind enough to both donate her old glasses today and to discuss her results with me.

 

 

 

EyeCare 20/20 Supporting AmeriCares: Help Japan and Save on LASIK

With over 161,000 people still living in evacuation centers more than three weeks after the massive earthquake and tsunami, and thousands more who have nowhere to go and are living in their cars, the humanitarian condition in Japan is still dire.  According the World Health Organization, more than half of the hospitals located in the hardest hit cities of Miyagi, Iwate and Fukushima prefectures have reached full capacity and are unable to accept new patients, and 33 hospitals are unable to accept any patients at all due to lack of resources and staff.  

The first emergency airlift of medical supplies from AmeriCares has arrived in Japan.  The more than 17 tons of critical aid is being received by Tohoku University Hospital in Sendai to support health care efforts in the devastated region.

AmeriCares is a nonprofit disaster relief and humanitarian aid organization which provides immediate response to emergency medical needs - and supports long-term humanitarian assistance programs - for all people around the world, irrespective of race, creed or political persuasion. AmeriCares has developed partnerships here in the U.S. and around the world that ensure that for every dollar you donate to AmeriCares, they can deliver $35 in lifesaving medicines, medical supplies and humanitarian aid to the people who need it the most.

From now until June, EyeCare 20/20 is supporting AmeriCares and their continuing relief efforts for those affected by the Japan Earthquake and Tsunami. You can help too,  make a $50 donation to AmeriCares and we will match the donation and give you $500 off a bilateral LASIK procedure.

One Year after Gold Medal: Curt Tomasevicz Still Enjoying His New Vision!

 

Curt Tomasevicz, a member of Team USA's gold medal winning 4-man bobsled, Night Train, dropped us a note last week, thanking us for his LASIK results:

"Life is so much easier without the discomfort and annoyance of contacts and glasses. I love being able to train without vision impairment as a distraction. I can focus on simply improving my strength and speed to push the sled. This hassle-free training allowed me to reach my best at the 2010 Olympics and win the Gold medal. Thanks Dr. Silverman and staff for playing a key role in my success!"

He also sent along some awesome memorabilia including a signed copy of the Sports Illustrated cover featuring the Night Train.  I can't wait to have them framed and hanging on the office walls!  Thanks Curt!

Food For Sight

The old adage is food for thought, but these days we are more interested in food for our sight. Just like there are foods to help your digestive system and foods for your heart there are also good quality and nutritious foods that are good for improving your eyesight.

While many are happy to make do with their less than perfect eyesight and will just accept the use of glasses or contacts to boost their sight, this just isn’t the frame of mind for others. You can be proactive and eat the following foods for the benefits that they have for eyesight. In conjunction with some eye exercises you will limit the need for glasses or contact lenses, at least for a little while.

Carrots contain vitamin A which is essential for healthy eyes and sight. This is found in the antioxidant beta carotene. Carrots are one of the best choices for getting your daily quotient of recommended vitamin A, but if they are not your favorites then you can also try cabbage and dark green lettuce instead.

Spinach is a wonder vegetable that helps protect you against eye diseases. The carotenoid lutein which is found in spinach helps to protect your eyes from cataracts and macular degeneration.

Fruits such as kiwis, oranges and certain berries are full of vitamin C. Vitamin C eliminates those free radicals which can cause damage to your eyes.

Soy is another of those recent wonder foods that have come into mainstream popularity over the past decades. Soy contains phytoestrogens, vitamin E and natural anti-inflammatory agents which are great at helping to promote healthy eyes.

Garlic contains sulfur which helps to make your lenses more resilient and stronger. If you don’t like the taste of garlic then feel free to try onions instead as they are also a great source of sulfur.

Eggs are absolutely amazing for eyes, no matter which way you choose to cook them. Eggs contain cysteine, sulfur, lecithin, amino acids and lutein. Not only do they promote good eyesight, they also help protect against cataracts.

Good quality dark chocolates contain flavonoids which protect blood vessels within the body including those in the eye. The strengthened blood vessels will increase the vitality of your cornea as well. Only pure good quality chocolate will work as it needs to have a high cocoa percentage. So eating a Hershey’s bar isn’t going to help you, even though you might find them rather tasty.

Some great tasting and healthy foods to improve your eyesight, and with the list including chocolate, everyone should be happy.

Dysfunctional Lens Syndrome: Describing the New Paradigm

I had a 60 year old patient in the office today who I told that she had "early" cataracts.  She was a moderate farsighted patient who was seeing 20/30 with her current glasses, and will see 20/20 with her new bifocals.  Now, without her glasses, she is able to see only 20/200 at both near and far.  Her question to me was, "Are my cataracts 'ripe' enough to come out?"  I gave her my standard "canned" answer:  "we don't wait for cataracts to be 'ripe' to remove them.  The time for cataract surgery is when you are unhappy with your vision, are unable to do all the things you would like to because of your vision, and I can't improve it to your satisfaction with a change in glasses." 

This is the standard answer that most ophthalmologists and I will give to patients when their insurance will be paying for the surgery, as there are certain criteria that must be met.  Specifically, best corrected vision should be worse than 20/40 and interfering with daily lifestyle.  With the aging of the Baby Boomer Generation, and improved refractive lens based technology, I have noticed a paradigm shift in how I view and discuss cataracts.

First, a little anatomy.  Think of the eye as a camera.  The front surface is a clear window, called the cornea.  Behind the cornea is the colored part of the eye, the iris, which acts like a diaphram in a camera.  It opens and closes to adjust the amount of light coming into the eye by changing the size of the pupil.  Behind the pupil is the lens.  When we are young, the lens is clear and able to easily change its shape to focus light onto the back of the eye, the retina.  The retina acts like the film in a camera.

Today's discussion will be limited to the lens as I will be describing a new terminology first described by Harvey Carter, MD:  Dysfunctional Lens Syndrome. 

As I mentioned, when we are young, the lens is clear and is able to change its shape, to focus.  This is called accommodation.  Aging affects the lens.  First, the lens begins to stiffen and lose its ability to change shape and focus.  This is called presbyopia, and usually manifests itself in the early 40's, when we start to need reading glasses.  Presbyopia will continue over the years, making focusing more and more difficult, ultimately leading to the need for bifocals.  As we continue to age the lens then loses its clarity and begins to opacify, leading to the formation of a cataract, or cloudy lens.  The cataract will continue to get more and more cloudy over time until it is very hard and dense, a ripe cataract.  When a cataract is "ripe", the patient is generally blind in that eye, and cataract surgery is very difficult.

So how do we treat Dysfunctional Lens Syndrome?  It depends on what the patient wants:

• Early on reading glasses are used as needed.
• When distance is also effected, bifocals are prescribed.
• Bifocal contact lenses and monovision contact lenses are prescribed to those who do not want to wear glasses.
• Refractive Lens Exchange (RLE) works very well for those patients who do not want to wear glasses or contact lenses.  RLE involves removing the dysfunctional natural lens and replacing it with a multifocal artificial lens (IOL) that is capable of focusing light near and far.  It is the same procedure as cataract surgery, except there is not enough lens changes (cataracts) for insurance to pay for the procedure.
• Once cataracts become visually significant, they may be removed to improve one's vision.  Again there are several choices here, depending on the patient's needs:
  • A standard IOL will provide excellent distance vision, provided there is no corneal astigmatism.  Astigmatism occurs when the eye is oval in shape, resulting in unequal refraction. Light rays are focused at two different points on or before the retina, and this split focus produces distorted vision.  Cataract surgery does not correct this and bifocals will be needed after surgery.  If there is no astigmatism, only reading glasses will be needed, as the standard IOL provides no focusing for close.
  • For those that do not want to wear glasses after cataract surgery, a premium IOL may be implanted. Insurance does not pay for the premium IOL, or the added visits and testing that is required.  Let’s break premium IOL choices into 2 categories:
    • No pre existing astigmatism:  In these patients, a multifocal IOL is implanted to achieve glasses free vision at both near and far.
    • Pre existing astigmatism:  In these patients there are 2 choices:
      • If one wants to have glasses free vision both near and far a multifocal IOL is implanted to address the near vision problem.  Astigmatism correction will than be addressed with LASIK about a month after the cataract surgery.
      • If one only wants good distance vision without glasses, a Toric IOL is implanted.  These patients will than only need over the counter reading glasses.

In summary, the new paradigm of discussing Dysfunctional Lens Syndrome allows me to discuss the changes in the natural lens, and how they affect my patient’s lifestyle requirements more effectively.  My discussion is no longer limited to the term "cataract", with its conotations of being a disease of "old age."

LASIK: "It's a Totally Different World"

Tristan Pittmann had LASIK this week.  Tristan has been wearing glasses for distance since he was 8 years old.  He's been thinking abut it for over 5 years.  But like many of our patients, he was nervous to undergo the procedure.  After the LASIK he commented to me, "I can't believe I waited so long to have it!"  I wish I had a dollar for every patient that has said that to me...

Tristan was kind enough to discuss his LASIK experience at EyeCare 20/20:

 

Give to the Valerie Fund & Save on LASIK!

Join EyeCare 20/20 in our continuing efforts to give back and help others in need in our community. Thru the month of March, we will be supporting The Valerie Fund, an organization that provides support for the comprehensive health care of children with cancer and blood disorders. Simply donate $50.00 to The Valerie Fund and we'll match it, and you will receive $500 off a bi-lateral LASIK procedure. It's our way of saying thanks for helping support this worthy cause.
 
Established in 1976 in memory of nine year old Valerie Goldstein, by her parents Ed and Sue, The Valerie Fund provides state-of-the-art outpatient health care throughout the tri-state area for children with cancer and blood disorders . Patients receive far more than treatment for their physical illnesses, as the philosophy of The Valerie Fund is to treat them emotionally, socially and developmentally, as well as medically.

Eye Drop to Prevent Cataracts?

For many, the formation of cataracts is a natural part of the aging process, causing the eye's natural lens to cloud and distort vision. The lens is held inside a capsule, and is made of mostly protein fibers and water arranged precisely so as to permit light to pass through without interference. Over time, these fibers begin to break down and cluster together, clouding the lens. As more fibers break down, the clouding becomes denser and covers a greater area of the lens. Cataract surgery becomes necessary to restore clear vision.

In China, there is a non-prescription eye drop that has been used for over 60 years to prevent and treat cataracts.  The active ingredient of this drop is caled pirenoxine (PRX).  There has been no scientific basis for the effectiveness of PRX, until now...

In last months issue of Inorganic Chemistry is an article titled Ditopic Complexation of Selenite Anions or Calcium Cations by Pirenoxine: An Implication for Anti-Cataractogenesis.  In the study, Tzu-Hua Wu and colleagues tested PRX on cloudy solutions that mimic the chemical composition of cataracts. The solutions contained crystallin -- a common lens protein -- combined with either calcium or selenite, two minerals whose increased levels appear to play key roles in the development of cataracts. Presence of PRX reduced the cloudiness of the lens solution containing calcium by 38 percent and reduced the cloudiness of the selenite solution by 11 percent.

"These results may provide a rationale for using PRX as an anti-cataract agent and warrant further biological studies," the article notes.  Who knows, there may be a time in the not to distant future when we will be prescribing these drops to ward off cataract surgery!

No More Glasses in the OR With the ReSTOR IOL!

I work in a very busy outpatient surgery center.  We have over 20 ophthalmologists performing thousands of cataract surgeries yearly.  Several months ago, one of our OR nurses, Linda, approached me.  She was sick and tired of wearing bifocals to drive, work on the computer, chart notes, and eat.  After speaking to many of my patients and their new abilities to function glasses free, Linda decided to pursue her options.  I told her to make an appointment at my office so that I could examine her and give her a recomendation.

It ends up that Linda was moderately farsighted, she needed glasses for all visual tasks.  She also had some small cataracts that were affecting her night driving.  After some more discussion, we decided that cataract surgery with the implantation of the ReSTOR IOL would give Linda the best chance of reducing her need for spectacles.

Linda had her surgery last month, and is now 20/20 both near and far without the need for glasses.  Needless to say, she is thrilled.  In fact today she told me she is bringing a "jealous" friend to my office next week to see what her options are.