Eye Care & Surgery Center NJ Bladeless LASIK Laser Cataract Surgeon Blog

Tuesday, November 29, 2011

Can a Cataract Grow Back?

“The actual Cataract Surgery procedure involves removing the cloudy crystalline lens of the eye so that once a Cataract is removed, no, it cannot come back”, explained Ivan Jacobs, M.D. a Cataract Surgeon and Glaucoma Specialist at Eye Care & Surgery Center. “But what can happen that might make it seem like the Cataract has returned is a condition called “posterior capsular opacification,” commented Joel Confino, M.D. a Cataract Surgeon and Corneal Specialist at Eye Care & Surgery Center. The crystalline lens of the eye is where a Cataract forms. “The crystalline lens has a soft protein center and is surrounded by a capsule-kind of like the structure of an M&M candy,” said Dr. Confino. A Cataract forms because the protein becomes cloudy. During Cataract Surgery Drs. Jacobs and Confino use microscopic instruments to break up and remove the cloudy material as this is what blurs your vision. However, they leave the “capsule” in intact and actually place the intraocular lens implant (IOL) to correct vision inside the capsule to help correct your vision. In some patients the capsule become “opacified” some time after surgery leaving the patient’s vision cloudy and often with glare sensitivity much like the symptoms they had from the Cataract. Fortunately, using a YAG Laser, Drs. Jacobs and Confino are able to quickly, safely and effectively create an opening in the capsule along the visual axis which restores the vision almost instantly. This procedure called a “YAG Capsulotomy” takes only a few minutes and is performed using simple eye drop anesthesia without discomfort. So, while cataracts do not come back a condition called “posterior capsular opacification” can make it seem like the Cataract has returned.

Please feel free to contact us with your questions or to schedule an appointment regarding Cataracts, Cataract Surgery or Lens Implants by calling Eye Care & Surgery Center at 908-789-8999.

Thursday, November 17, 2011

Baseline Eye Screening by 40

When Should You Have an Eye Exam?

The American Academy of Ophthalmology recommends that every healthy person have a baseline eye exam by age 40. An ophthalmologic evaluation can uncover abnormalities of the visual system and reveal signs of systemic disease such as high blood pressure and diabetes. This age is a time when eye diseases such as glaucoma, cataract or retinal conditions may be identifiable in their early form and treatment can have a tremendous impact.

Age 40 is also about the age when people develop presbyopia, a normal aging process where the natural lens of the eye starts to lose its ability to focus, creating the need to use magnifying glasses or bifocals to read. Patients with known diseases such as high blood pressure and diabetes should have regular eye exams at the time of diagnosis to search for signs of disease in the eye. The eye doctor would then determine appropriate intervals of follow-up care.

Other diseases such as autoimmune disease (lupus, rheumatoid arthritis, sarcoidosis, etc.), thyroid disease, sleep apnea, blood disorders and neurological conditions can also affect the eyes. People with a strong family history of eye diseases or blindness should call their eye doctor today to set up an evaluation.

Guest Blogger: Dr. Roslyn Stahl, M.D. Glaucoma & Cataract Specialist

Tuesday, November 15, 2011

How Safe Is LASIK?

The safety of LASIK is a key consideration for anyone thinking about Laser Eye Surgery for vision correction. It is important to understand the solid overall long term safety record as well as a look at what might be key factors that impact LASIK safety.

By far the most important factors that can affect LASIK safety are the laser and instrumentation to be used to perform the treatment and even more so, the skill and experience of the LASIK Surgeon.

Long Term Track Record
The use of the Excimer laser for performing Laser Eye Surgery for the Laser Vision Correction of nearsightedness was first approved in the United States by the Food and Drug Administration (FDA) on October 20, 1995. The Excimer Laser was specifically FDA approved for LASIK in 1998. So as of 2011, Laser Eye Surgery for vision correction has been performed for just over 16 years and the LASIK procedure has been performed under FDA approval for just over 11 years.

It is estimated that some 22 million patients worldwide have had LASIK.

LASIK is generally considered one of the most successful and safe surgical procedures of any type. Nearsighted patients can expect to achieve 20/40 vision more than 98 percent of the time and uncorrected vision of 20/20 or 20/25 more than 90 percent of the time. With regard to any loss of vision, it is quite rare to experience a loss of vision beyond 20/40 occurring in about only 3 per 1,000 cases and with regard to serious complications such as infection or corneal damage the risk is even less occurring in fewer than 1 in 1,000 cases. While not an infinite amount of time, the availability of the various Laser Vision Correction procedures, including LASIK for this 10-15 year timeframe with these results does give us access to real world experience and data that speaks to its long term safety record. But, there is more to safety than simply the FDA approval of the laser itself.

Safety is the Hands of the LASIK Surgeon
FDA approval does not ensure that a LASIK Surgeon is going to provide a thorough evaluation and consultation, does not imply that LASIK Surgeons will provide a complete review of the possible risks and complications of LASIK-nor does it imply that a LASIK Surgeon will use the appropriate screening and decision criteria to be sure that a patient is in fact a good candidate for LASIK or any Laser Eye Surgery for that matter.

So, with regard to LASIK safety, choosing a LASIK Surgeon is the most important decision a patient makes in deciding to have LASIK and is a significant part of making LASIK a safe and effective procedure. You should not choose a LASIK Surgeon based on slick advertising or low price. You should choose a LASIK Surgeon based on reputation in the community, the length of time they have been performing LASIK and the comfort and rapport established during your consultation. While the equipment used may provide a slight advantage or disadvantage in safety, it is ALWAYS the skill and experience of the surgeon that contributes the most to the overall safety of Laser Eye Surgery for the correction of nearsightedness, farsightedness and astigmatism.

The best way for you or someone you know to really learn all they need to know about LASIK safety is to find out if they are a good candidate for LASIK by having an evaluation, examination, and consultation with Dr. Confino who is a Corneal Surgeon and LASIK specialist. Please feel free to contact us schedule an appointment by calling Eye Care & Surgery Center Toll Free at 800.504.1083.

Tuesday, November 1, 2011

Diabetic Eye Disease Month at Eye Care & Surgery Center

Eye Care & Surgery Center wishes to announce that Prevent Blindness America has designated November as National Diabetic Eye Disease Awareness Month. This is an important time to spread the word about this potentially blinding disease. We need to work to help patients avoid the complications of diabetic retinopathy, which blinds over 8,000 Americans each year. The vision loss from diabetic retinopathy can be prevented if it's caught and treated in time. A recent study found that more than one third of those diagnosed with diabetes do not adhere to vision care guidelines recommending a dilated eye exam every year.

As part of Diabetic Eye Disease Awareness Month we are urging people with diabetes to have a dilated eye exam every year. The longer a person has diabetes, the greater his or her risk for developing diabetic retinopathy. However, diabetic retinopathy does not only affect people who have had diabetes for many years, it can also appear within the first year or two after the onset of the disease.

Patients can help to reduce the risk of developing diabetic eye disease by not smoking, controlling their cholesterol and lipid profile and blood pressure, as well as working to eat a heart-healthy diet rich in fish, fruit and green leafy vegetables and exercising.

The key to successful treatment of diabetic retinopathy is early detection and intervention. We are fortunate to have Milton Kahn, M.D. at Eye Care & Surgery Center, who is a fellowship trained in Diseases of the Retina and a specialist in the diagnosis and treatment of Diabetic Retinopathy. If you or someone you know has diabetes or is even prediabetic please feel free to schedule a diabetic eye examination at Eye Care & Surgery Center by phoning 908.789.8999.

Thursday, October 6, 2011

Eyewear for Athletes of All Ages

Protective sport eyewear is highly recommended for children and adults participating in sporting activities. Eye injuries happen to be the leading cause of blindness in children according to the NEHEP & The National Eye Institute. In the United States, emergency rooms treat a sports-related eye injury, on average, every 13 minutes, one third of which involve children.

Sport eyewear not only protects the eye but may assist athletes in achieving maximum performance levels. Almost every prescription can be placed in this specialty eyewear and lenses that adjust for sun exposure may also be used. There are many sizes and designs available to meet the needs of all athletes big and small, professional and recreational.

Sporting glasses have been successfully used for some physically challenged patients that may have difficulty keeping their eyewear in place.

Thank you to our Guest Blogger Amy Shabat, Licensed Optician in our Westfield office.

Tuesday, October 4, 2011

Eye Injury Prevention Month at Eye Care & Surgery Center

The Eye Care & Surgery Center wishes to announce that October has been designated Eye Injury Prevention Month by the American Academy of Ophthalmology. When most people go out to mow the lawn, jump-start the car or get ready to do some spring cleaning, the last thing they think about is protecting their eyes, but it should be first on their mind. It is a good idea to think about protecting your eyes from the extraordinary damage often caused by the most ordinary of activities.

Many household chemicals, such as cleaning fluids, detergents and ammonia, are extremely hazardous and can burn the eye's delicate tissues. When using chemicals, always read instructions and labels carefully, work in a well-ventilated area and make sure spray nozzles point away from you and others before spraying. Be sure to wash your hands thoroughly after use.

Before using a lawnmower, power trimmer or edger, check for debris. Stones, twigs and other items can become dangerous projectiles shooting from the blades of a lawnmower, potentially injuring your eyes or those of innocent bystanders. Prevention is the first and most important step in avoiding serious eye injuries, so be sure to protect your eyes with appropriate protective eyewear.

Please feel free to contact us with your questions or to schedule an examination by calling The Eye Care & Surgery Center Toll Free at 800-504-1083.

Tuesday, September 27, 2011

Children’s Eye Exam: When Should My Child Have an Eye Exam?

Eye examinations begin in the hospital nursery when a baby’s eyes are examined for a clear strong red reflex indicating a clear pathway for light to enter the eye. Though uncommon, blockage of the visual axis in infancy, such as with a cataract, must be addressed in the first weeks of life to avoid permanent loss of vision.

This type of assessment is repeated on follow up visits to the pediatrician for well baby care at which times testing for strabismus or eye alignment is also performed. More formal vision testing with an eye chart of picture symbols or letters is typically attempted in the three to four year old range. The recommendation is for this to occur as well in the pediatrician’s office during well child appointments. Each eye is tested individually, as poor vision in one eye may not be evident in the normal course of the child’s lifestyle. Some newer photoscreening devices can provide objective measurements of vision in preverbal children. If results are normal during this testing, examination by an eye doctor is not necessary. If any testing is abnormal or inconclusive or parents notice any vision or eye abnormalities, a referral to a Pediatric Ophthalmologist may be indicated.

Louis Furlan, M.D.
Thank you to our guest blogger: Louis Furlan, M.D., Pediatric Ophthalmologist at The Eye Care & Surgery Center

Thursday, September 22, 2011

LOW VISION AIDS: Using Technology to Help You Read

Many of our patients suffer with Macular Degeneration or other diseases of the eye that restrict their ability to read comfortably. With the advancements in technology, there are now options for patients with low vision that may make daily activities, such as reading the newspaper or their favorite book, possible.

Ivan Jacobs, M.D., often recommends his patients begin using a tablet computer for reading. The images are brighter, bigger and sharper. The size of the font and graphics is at the control of the user by simply dragging their fingers across the screen.

Dr. Jacobs has seen patients who had given up trying to read as a result of degeneration of their vision, now reading and researching with ease and clarity with the help of technology based instruments. As always, speak with your own ophthalmologist regarding your specific limitations and expectations.

Tuesday, September 20, 2011

Types of Contact Lenses: Which One is Right for Me?

Contact lenses have advanced tremendously in the last decade. As a result, there are several options available to consumers. When choosing an appropriate contact lens, several factors are taken into consideration. These factors include lifestyle, expense and the type of vision correction needed. Contact lenses can be worn by people of varying ages.

There are two main types of contact lenses; rigid gas permeable contact lenses and soft contact lenses. There are subsets of each type of lens to correct refractive errors such as Toric contact lenses for the correction of Astigmatism, Bifocal lenses, and Multifocal contact lenses.

Rigid gas permeable contact lenses are made of a more rigid material and are subsequently more durable than soft contact lenses. Rigid gas permeable contact lenses are often used for people with corneal irregularities.

Soft contact lenses are the most popular type of contact lens. The majority of soft contact lenses are disposable meaning they can be thrown away after a short period time. Disposable contact lenses can be replaced daily, bi-weekly, monthly or every three months. The main advantage of disposable contact lenses is that they decrease the risk of infection because there is less likelihood of protein build up.

Toric (Astigmatic) contact lenses are designed to correct astigmatism. Astigmatism occurs when the cornea has a curvature that resembles a football rather than a basketball. Toric contact lenses are available in soft and rigid gas permeable materials.

Bifocal contact lenses are designed to correct presbyopia. Presbyopia is the change in the natural lens of the eye that generally affects people in their early 40s. Bifocal contact lenses correct distance and near prescriptions simultaneously.

Multifocal contact lenses have multiple focal points that may assist in enlarging the range of vision to include some mid-range vision as well.

In conclusion, regardless of the type of contact lenses a patient wears, proper hygiene is essential in the maintenance of contact lenses to prevent infections and to obtain optimal vision. Individuals interested in contact lenses should consult an eye care professional.

Thank you to our Guest Blogger Hanifah Haamid, lead contact lens technician and A-Scan Specialist. Hanifah also has a YouTube Video on the Top 5 Contact Lens Questions.

Thursday, September 15, 2011

Your LASIK Evaluation-What to Expect?

The only way to confidently know whether LASIK or any type of Laser Eye Surgery for vision correction is going to safely, effectively and predictably help you achieve your personal vision correction goals is to have a thorough evaluation and consultation. The LASIK evaluation should be thorough enough to gather sufficient clinical and personal information so as to enable your LASIK Surgeon to make proper recommendations about to proceed. Your LASIK consultation should consist of a number of clinical tests including:

  • Measurement of your uncorrected visual acuity

  • Measurement of your visual acuity with your current eyeglasses or contact lenses

  • Optical measurement of the current prescription that you are wearing in your eyeglasses and/or a review of your current contact lens prescription

  • A thorough review of your medical and eye history including all prescription and non-prescription medication that you have been or are currently taking

  • A refraction-automated or manual-to determine your current prescription

  • A topography measurement to digitally map the shape of your cornea

  • A pachymetry measurement of the thickness of your cornea

  • A measurement of pupil size

  • A microscopic evaluation of the health of your cornea and tear film including testing for dry eyes

From this testing it can be determined whether you should proceed to the final level of testing whereby the actual preoperative measurements are taken for your treatment and a thorough examination of the Retina and Optic Nerve can be performed.

In addition to the actual clinical testing your LASIK evaluation will include a full discussion of LASIK risks, benefits and complications and a thorough analysis of the personal goals and objectives that you feel are important to your success. The best way for you or someone you know to find out if they are a good candidate for LASIK is to have an evaluation, examination, and consultation with Dr. Confino who is a Corneal Surgeon and LASIK specialist. Please feel free to contact us schedule an appointment by calling The Eye Care & Surgery Center Toll Free at 800-504-1083.

Tuesday, September 13, 2011

A New Solution for Presbyopia

Vision Correction Surgery, both in the form of corneal laser surgery and refractive lens implant surgery, has made great advances in the treatment of near-sightedness (myopia), far-sightedness (hyperopia) and astigmatism. The “Holy Grail” of vision correction continues to be the search for a safe and effective correction of Presbyopia, or the age-related loss of reading ability. An ideal treatment would allow for enhanced reading ability without detracting from distance visual acuity, as current strategies, such as monovision, do.

A new and promising approach is the Kamra inlay. It is a synthetic disc, 3.8mm in diameter with a central 1.6mm aperture, composed of a bio-compatible material that can be safely and permanently implanted into the cornea of the “non-dominant” eye. This can be done under a corneal flap previously created during a LASIK procedure or under a newly-created laser flap. It works on the principle of “Small Aperture Optics”, or “the pinhole effect”, essentially what cameras use to get depth of focus. The central opening allows for light to be focused at near without detracting from distance visual acuity. If desired, the implant is reversible and potentially removable at any time.

Although currently classified as an “investigational device” enrolled in studies in the USA, it is approved and freely used in Europe and Asia, where it has been shown to deliver high-quality visual results. We are looking forward to it receiving official approval for use in the USA and bringing it into our office laser refractive suite to offer to our many interested patients. Our Ziemer femtosecond laser has been specially equipped with the ability to create the corneal flap for the Kamra inlay, and can be used in conjunction with LASIK procedures or as a stand-alone treatment for presbyopia.

Thank you Dr. Joel Confino, today’s guest blogger.

Wednesday, September 7, 2011

Cataract Risk and Celiac Disease

Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, rye, and possibly oats. The exact cause of celiac disease is unknown. The lining of the intestines contains areas called villi, which help absorb nutrients. When people with celiac disease eat foods or use products that contain gluten, their immune system reacts by damaging these villi. This damage affects the ability to absorb nutrients properly. A person becomes malnourished, no matter how much food he or she eats.

As a result of being malnourished, Vitamin deficiencies are common in celiac disease (CD). Vitamin deficiencies are also associated with cataract formation, and a recent study confirmed that persons with Celiac disease are at increased risk of cataract. Reporting in the American Journal of Epidemiology researchers found an excess and increased risk of cataract formation in Celiac disease sufferers.

Thursday, September 1, 2011

LASIK or PRK-Which One for Me?

Some patients may be given the option of having either Bladeless LASIK or PRK and could have a difficult time deciding which one might be the best choice. Here is some information that may be helpful as patients go through the decision making process.

In terms of the actual vision correction outcomes, both PRK and LASIK produce almost identical visual results. However, there are some slight and other not so slight differences between LASIK and PRK.

Long Term
There are some studies that show that patients who have LASIK may have very slightly reduced contrast sensitivity in dim illumination. If one uses extremely sensitive clinical measuring methods they can sometimes find a slight reduction in “low contrast” vision such as driving at dusk or in rainy conditions. Often it is so slight that the patient doesn’t even notice it as they navigate their daily routine. This really is a limited problem for most patients.

The real differences between PRK and LASIK are based on the fact that PRK is a “surface treatment” and LASIK is a “lamellar treatment”. That is, PRK is performed on the surface of the cornea whereas LASIK is performed between the layers of the cornea. To perform Bladeless LASIK Dr. Confino first creates a “layer” or a “flap” using the femtosecond laser for greatest precision and accuracy. He then carefully folds back the “flap” and applies the excimer laser to reshape the cornea to give the right prescription for your vision correction. Then he replaces the “flap” into its original position where it “sticks” without the need for stitches or sutures. So it is really a 3-step procedure. To perform a PRK is a single step procedure, just applying the laser. Whenever you have a multi step eye surgery procedure this is always a greater risk of complications and side effects. However the risks, side effects and complications of LASIK are relatively few and minor if you are selected as a good candidate and under the care of Dr. Confino. So, PRK does offer a safer risk profile because it is a single step procedure.

One of the not so subtle differences is that because LASIK is a lamellar procedure, LASIK Surgery does not disturb the surface of the cornea during treatment. This provides patients with a much faster visual recovery and significantly less discomfort than PRK. This is why from a consumer perspective patients prefer LASIK over PRK. They can get back to pretty much normal activities within a couple of days without any real pain-just some mild discomfort-and with good vision. Most LASIK patients are able to pass a drivers test with 24-48 hours of their laser treatment. PRK patients often experience moderate discomfort that can last a few days and depending on the degree of their prescription can take a week or so to achieve good functional comfortable vision.

The best way for you or someone you know to find out if they are a good candidate for LASIK is to have an evaluation, examination, and consultation with Dr. Confino who is a Corneal Surgeon and LASIK specialist. Please feel free to contact us schedule an appointment by calling The Eye Care & Surgery Center Toll Free at 800-504-1083.

Tuesday, August 30, 2011

Lens Coatings for Glasses-Which Are Best for Me?

There are many types of lenses and coatings available when purchasing glasses. It is sometimes difficult, if not being advised by a licensed optician, to know which coating(s) are going to provide the clearest and most effective vision. The first step in making an educated decision is to understand the different coatings/lenses and what each provides.

Polycarbonate Lenses
This lens has scratch resistant coating, is lightweight and is shatter resistant. This is a must for children and for active people playing contact sports where you can get hit.

Scratch Resistant Coating
This coating helps prevent the lenses from getting scratched easily. However it is not 100% scratch proof.

Ultra Violet Coating
Eyeglass lenses can be coated to diminish the amount of UV radiation that passes through. This coating is recommended to protect the eyes from UV rays which can cause several serious eye problems.

Anti-Reflective Coating (AR Coating)
This coating reduces distracting glare particularly to patients who have trouble with driving at night. AR coating eliminates scattering of light, thus eliminating confusion and glare especially for light sensitive patients.

Photochromic Lenses
The lens tint adjusts from clear to dark, depending on changing light conditions.
This is helpful for patients with prescription lenses who hate switching from eyeglasses to sunglasses.

Polarized Lenses
This is considered the best sunglass lens because it reduces glare and provides high contrast vision with maximum UV protection available. It is great for driving and any outdoor activity.

Lynette Cababa is the Optician in our Warren Location. We are very grateful she agreed to be our guest blogger today.

Friday, August 26, 2011

Cornea Cell Count: Why is it Important?

The inner lining of the cornea is a layer of tissue called the endothelium. It consists of a layer of cells that resemble a “tile floor” under the microscope. This lining is important because it serves as a water “pump”, pumping water out of the cornea back into the eye, which is necessary to maintain the cornea’s clarity. The number of cells per unit area, or density, determines how well the cornea can perform this important function.

Using an instrument called a specular microscope, an “endothelial cell count” can be performed to look at the density, size, and shape of the cells. The density of the cells can be affected in certain diseases, such as Fuchs Corneal Endothelial Dystrophy and can be monitored. The density may also affect the decision making of related eye surgeries such as cataract surgery, where the cornea could be further damaged and de-stabilized, requiring a corneal transplant. A variation in size of cells called “pleomorphism”, can be seen in other diseases, and polymegathism, (a variation in the size of endothelial cells), can be seen in contact lens wearers and may represent a sign of disturbed metabolism. If contact lens wear is reduced or discontinued, a return to proper cell shape can be observed.

In summary, your doctor may use your cell count to document a disease process, aid in planning the treatment of a corneal disease, document the delivery of medical treatment and the response to that treatment, and for patient education.

Our Guest Blogger: Dr. Joel Confino, M.D.: Cornea Specialist at The Eye Care & Surgery Center of Westfield, Warren and Iselin New Jersey

Wednesday, August 24, 2011

Glaucoma and Generic Medications

Brand name drug development is important in all fields of medicine. Without patent protection, pharmaceutical companies cannot spend the hundreds of millions of dollars required to develop new medications. After a period of time however, the patent on these medications expire and the medication is allowed to be manufactured in a generic equivalent formulation. As a result, the cost drops on the brand as generic manufacturers are able to produce these equivalents. Fortunately, the majority of commonly prescribed glaucoma brand medications now have generic equivalent. It is important to realize that generic equivalents are chemical copies but the clinical equivalence is not guaranteed. However, it appears presently, that the generic medications are equal in efficacy to the branded medications.

An example of some of the generics that are available currently for Glaucoma medications are: Timolol (beta blocker) the generic equivalent of Timoptic, initially developed by Merck. It is usually in an aqueous form or gel forming solution (GFS). Trusopt (topical carbonic anhydrase inhibitor), also developed by Merck, is now dorzolamide. Alphagan (alpha agonist) from Allergan is now brimonidine. Xalatan (prostaglandin) from Pfizer is now latanaprost. Cosopt (timolol with dorzolamide) is now called timolol-dorzolamide.

Whether your pharmacy dispenses the branded or generic medication is usually dependent on your insurance plan’s directions. However, it is still possible to get branded medications if for some reason the generic substitution is less than adequate.

Thank you Dr. Ivan Jacobs M.D-Glaucoma Specialist: The Eye Care & Surgery Center.

Friday, August 19, 2011

Recovery from Cataract Surgery

“As with any type of surgery, our patients always want to know what to expect in terms of recovery after Cataract Surgery”, said Ivan Jacobs, M.D. of The Eye Care & Surgery Center. Cataract surgery today is really quite advanced and generally pretty “patient friendly”.
Here is what Cataract patients should know and expect at The Eye Care & Surgery Center.
“If you are in good general health it is most likely that your Cataract operation will be performed in our ambulatory surgery center. This eye surgery facility is comfortable, efficient and close to home for most of our patients. Usually, your entire Cataract Surgery procedure should take only 2-3 hours from the time you check in until the time you check out”, stated Joel Confino, M.D.Advanced Cataract Surgery today is most often performed with “topical eye drop anesthesia”-that is, for most patients the only anesthesia required are some eye drops along with a tablet to help you relax. There is really minimal if any “recovery” from the anesthesia used”, commented Dr. Jacobs.

According to Dr. Jacobs patients are usually feeling “back to normal” by the end of the day of their surgery or certainly by the next morning. Dr. Confino shared, “With the advanced Cataract Surgery technique of “small incision phacoemulsification” there is only a need to create a tiny incision-often just a few millimeters-through which the Cataract is removed and the Intraocular Lens is implanted. This tiny incision is so small so as not to require any “stitches” or sutures in many cases.” Thus the wound healing is very quick. Finally, depending on the type of lens implant that you have it is highly likely that your distance vision will be dramatically improved within 24 hours. In fact many patients actually are comfortable driving the next day after their Cataract operation. If you have a multifocal or accommodating lens implant to correct both your distance and near vision, it might take a bit longer to appreciate the full clarity of the near vision correction. So, it is pretty likely that you will be back to work in a few days and depending on your specific instructions. Generally, you should be able to resume all of your normal activities with a couple of days.

Please feel free to contact us with your questions or to schedule an appointment regarding Cataracts, Cataract Surgery or Lens Implants by calling The Eye Care & Surgery Center at 908-789-8999.

Tuesday, August 16, 2011

Glaucoma Medications: Compliance is Key

As a glaucoma specialist I often prescribe medication to lower patients' eye pressure. Glaucoma is a disease that can lead to permanent vision loss when the pressure in the eye is too high. Most patients with glaucoma do not have any symptoms until it is very advanced. The vision loss from glaucoma occurs very slowly over the course of many years. Once treatment for glaucoma is established, the goal is to keep the disease process stable. Unfortunately, there is no cure for the disease but there are different treatment options available.

Often a patient will stop taking their glaucoma medication because they don’t see a difference with the treatment or feel they are getting worse with the drops. In fact, sometimes the eye drops can cause burning, redness or a transient blurring of vision causing patients to discontinue their treatment without discussing it with their eye doctor. It is essential that the patient discuss these side effects with their doctor and look for an alternate drop or treatment if they are unable to tolerate their current regimen. It is important to understand that even if you feel that the medication may not be working well to continue to treat the glaucoma.

Some patients have trouble remembering to take their medications. Using the drops once in a while can cause wide fluctuations in pressure that may be harmful for the optic nerve. The only way to prevent further damage is by using them as prescribed. If you have trouble remembering the drops then speak with your doctor so you can come up with a schedule that may be easier for you to remember.

I always ask my patients to be honest about how and when they are taking their medications. Some patients take their drops only when they go to the doctor. This can be confusing for the physician because the patient’s exam and tests may show that the glaucoma is worse but the eye pressure readings during the visit seem adequate. The doctor then may decide that the goal eye pressure should be lower and may recommend more medication, laser or surgery.

Glaucoma medications are important to save your sight but they only work if you take them. If for any reason you are having trouble taking them please discuss this with your doctor. They can help find a solution for you.

Guest Blogger: Roslyn Stahl, M.D. Glaucoma and Cataract Surgeon at The Eye Care & Surgery Center

Thursday, August 11, 2011

Protecting Your Eyes While Swimming-What Precautions to Take

It is recommended not to swim with your eyes open under the water and, when possible, to avoid splashes into your eyes. Pool chemicals and pH levels will affect your eyes when they are open, while you are swimming. Anyone spending an extended period of time in the water should protect their eyes by wearing goggles. If you worry about not being able to see clearly without glasses or contacts and want to see while in the pool, you may want to consider prescription goggles.

It is a common misconception that the chlorine in the pool will cause a swimmer's eyes to burn. In order for chlorine to be the cause, the chlorine level would have to be extremely high. The more likely reason people’s eyes sting or burn after swimming is the pH is not in balance. Keeping in mind that the tears produced by human eyes has a pH of 7.0, if the pH of the pool water is below that level, it will certainly cause the eyes to burn. The proper pH level for swimming pools is in the range of 7.2 to 7.8. If your pool's pH is kept within this range, burning eyes shouldn't be a problem for swimmers in your pool.

Swimming with your contact lenses on, is possible but very risky. The health risk associated is merely dependent upon the body of water you are in. When swimming on lakes and rivers, there is a huge possibility for a microorganism called acanthamoeba to adhere to your lens, causing infection and inflammation of your cornea (acanthamoeba keratitis). Swimming around pools and ocean waters on the other hand, decreases your susceptibility to microbial infection, but other problems may evolve. In the pool--eye irritation is possible when chlorine sticks on the surface of your lens; in the ocean--your contact lenses can be dislodged when you encounter large waves. You can still wear your lenses, but do so with proper precautions. Obviously keeping your head out of the water will reduce risk greatly.

Remove the contact lenses and consult an ophthalmologist immediately if you experience symptoms such as redness, pain, tearing, increased light sensitivity, blurry vision, discharge or swelling.

Thank you to our guest blogger Milton Kahn M.D, for sharing safety tips to help enjoy our summer to the fullest.

Tuesday, August 9, 2011

Cataract & Prostate Cancer Treatment

Researchers reporting in the Annals of Epidemiology (November 2010) identified that the risk of developing Cataracts may be higher in patients being treated for prostate cancer with Androgen Deprivation Therapy (ADT). The side effects of ADT such as weight gain, insulin resistance and blood lipid level problems have been linked to Cataract formation. Although further prospective study is necessary to truly understand the findings, researchers from Karmanos Cancer Institute in Detroit used the Surveillance, Epidemiology and End Results Medicare database to analyze cataract formation in prostate cancer patients and concluded that a significantly greater risk was presented when patient being treated for prostate cancer were on ADT.

Please feel free to contact us with your questions about Cataracts, Cataract Surgery or Lens Implants by calling Eye Care & Surgery Center at 908-789-8999.

Tuesday, August 2, 2011

Children's Eye Health Month

Eye Care & Surgery Center wishes to announce that August has been designated as Children’s Eye Health and Safety Month by Prevent Blindness America. “Eye and vision problems affect one in twenty preschoolers and one in four school aged children”, said New Jersey Pediatric Ophthalmologist Louis Furlan, M.D. at Eye Care & Surgery Center. “Parents should be aware that it is possible for their children to have a serious vision problem without even being aware of it.”

Infants should be screened for common eye problems during their regular pediatric appointments and vision testing should be conducted for all children starting at around three years of age. If there is a family history of eye problems or if an eye problem is apparent, it is important to bring it to the attention of and eye doctor so that they can advise the parents about when and how often their child’s eyes should be examined.

Among the conditions an eye doctor will look for are amblyopia (lazy eye), strabismus (crossed eyes), ptosis (drooping of the upper eyelid), color deficiency (color blindness) and refractive errors (nearsightedness, farsightedness and astigmatism). We are fortunate to have Louis Furlan, M.D. at Eye Care & Surgery Center who is a fellowship trained in Pediatric Ophthalmology and a specialist in the diagnosis and treatment of children’s eye problems.

Friday, July 15, 2011

Lucentis for Diabetic Eye Disease

“Clinical results from the two-year study of the anti-vascular endothelial growth factor (VEGF) drug Lucentis were quite positive when used to treat Diabetic Macular Edema (DME), which is a cause of significant vision loss in patients with diabetes”, commented Milton Kahn, M.D. a New Jersey Retinal Specialist at Eye Care & Surgery Center. “Patients with Diabetic Retinopathy in the form of DME who received the drug experienced rapid and sustained improvement in vision compared to those who received a placebo injection.”

Diabetic Macular Edema or DME is the swelling of retina in people with diabetic eye disease called Diabetic Retinopathy, which causes damage to the blood vessels of retina. The DME patients suffer fluid leak from the damaged blood vessel to the central portion of retina, causing it to swell leading to blurred vision, severe vision loss and blindness.

Of the 26 million U.S. people with diabetes, a portion of up to 10 percent tends to develop DME during their lifetime, and up to 75,000 new cases of DME are estimated to develop each year. Currently, DME patients are treated with laser surgery that helps seal the leaky blood vessels to slow the leakage of fluid and reduce the amount of fluid in the retina.

Lucentis is approved for use by the U.S. Food & Drug Administration (FDA) for the treatment of “Wet” Age-Related Macular Degeneration (AMD) and for Macular Edema following Retinal Vein Occlusion. In 2011, Lucentis was approved for treatment of visual impairment due to DME in Europe.

If you or someone you know suffers from diabetes or is even prediabetic they should have regular eye exams in order to protect their eye health and vision. Significant vision loss from Diabetic Retinopathy can often be prevented by early detection, diagnosis and treatment. Please call Eye Care & Surgery Center at 908-789-8999 to schedule an appointment.

Tuesday, July 12, 2011

How Do Skin Peels Work?

As an Oculofacial Plastic Surgeon, I see many patients searching for the best way to reverse the aging process and erase the damage that has been done to their skin. There are several methods available to accomplish different degrees of correction.

For my patients looking for a non-surgical method, I discuss skin treatments to address their challenging areas. One treatment in particular has proven to provide an overall rejuvenation of the skin; a full line of skin treatments from eyelid creams to medical grade chemical peels.

Then choosing a peel, it is best to discuss your objectives, skin sensitivities, past skin conditions and your daily activities with your clinician in order for them to make an informed recommendation on the proper peel regime for you. Though there are several chemical peels available, I have chosen a multi-tiered package for my patients that allow me to truly customize their treatment and results. The chemical peel package offers three levels of peels for treatment of fine lines and wrinkles in patients. The Level 1 or Illuminize peel is for patients with sensitive skin types or those that have skin that is more at risk for hyperpigmentation. The Level 2 and Level 3 peels (Vitalize and Rejuvenize) are stronger peels that have a longer and deeper effect. All sets of peels have no downtime but patients can expect to have mild skin peeling approximately 48 hours after the peel is administered. During that period, the old skin layer is flaked off to expose the newer skin layer underneath. The contents in the peeling solution are Alcohol, Salicyclic Acid, Resorcinol, Lactic Acid, Panthenol, Isoceteth-20. Additionally retinoic acid is used to pretreat the skin before treatment. This combination is used to increase skin glow and radiance and improve skin color, clarity and texture by increasing cell turnover in the skin. Most patients receive a treatment every 2 months.

All peels work differently. Discuss all your options with your clinical skin advisor before making any decisions and ask to see before and after photographs of their treated patients.

Thank you to Oculofacial Plastic Surgeon, Dr. Chris Thiagarajah, for being our guest blogger today.

Tuesday, July 5, 2011

Fireworks Eye Safety Awareness Month

Eye Care & Surgery Center wishes to announce that Prevent Blindness America has designated July as National Fireworks Eye Safety Awareness Month.

Contrary to what you might think, there is no safe way for nonprofessionals to use fireworks. It is only safe to enjoy the splendor and excitement of fireworks at a professional display. According to the U.S. Consumer Product Safety Commission, fireworks are involved in approximately 10,000 injuries per year that are treated in U.S. hospital emergency rooms. Of those, 2/3 occurred during the one month period surrounding the July 4th holiday. It is important to note that:

• Eyes were the Second Most Commonly Injured Part of the Body!
• Males Were Injured 3x More than Females.
• Approximately 25% of Injuries are to Children Under 15.

Fireworks and celebrations go together, especially during the Fourth of July. But there are precautions parents can take to prevent these injuries. The best defense against kids suffering severe eye injuries and burns is to not let kids play with any fireworks. Do not purchase, use or store fireworks of any type. Protect yourself, your family and your friends by avoiding fireworks. Attend only authorized public fireworks displays conducted by licensed operators, but be aware that even professional displays can be dangerous. If an eye accident does occur, what should I know?

• Do not rub the eye.
• Do not attempt to rinse out the eye. This can be even more damaging than rubbing.
• Do not apply pressure to the eye itself- but protecting the eye from further contact
with any item, including the child's hand.
• Do not stop for medicine! Over-the-counter pain relievers will not do much to relieve pain.
Aspirin (should never be given to children) and ibuprofen can thin the blood, increasing
bleeding. Take the child to the emergency room at once.
• Do not apply ointments or drops. They may not be sterile and may make the area around
the eye slippery and harder for the doctor to examine.

Once you are seen in the emergency room please feel free to have them call Eye Care & Surgery Center at 908.789.8999 as we always have an eye doctor “on call” to provide consultation and continued care for you.

Friday, July 1, 2011

Blepharitis–What is it?

Blepharitis is the most common inflammation of the eyelids. It may be asymptomatic or can cause irritation, burning, and redness of the lids or conjunctiva. People with a tendency towards dandruff, oily skin, acne rosacea or dry eyes are more frequently affected. Blepharitis can begin early in life affecting children and continue throughout life as a chronic condition or it can manifest itself later in life.

Each person has normal bacteria present on the surface of their skin and most people will never be bothered by it. This same bacteria, on certain individuals, tends to thrive at the base of the eyelashes. Irritation may result from an abnormality or over-activity of the nearby oil glands (meibomian glands) causing scales and particles to form along the lashes and eyelid margins.

The effects of blepharitis are different for each person. Some people are affected with only minor irritation and itching from the scales or bacteria, but others may be affected with redness and/or a burning sensation. An allergic response to the scales or bacteria that surround them may develop.

Treatment - Caring for Blepharitis
Treating blepharitis is more controlling the symptoms than curing the condition. Often times blepharitis cannot be cured, but it is possible to control the condition by following the instructions below:

1. Using a warm, moist washcloth, place it over the closed eyelids for a several minutes at least twice a day. It may be necessary to remoisten it as it cools down. This will be helpful to soften and loosen scales and other particles on the eyelids. This treatment also helps to prevent the development of a chalazion, which is an inflamed lump within an eyelid oil gland.
2. It is important to gently rub the base of the lashes about 15 seconds per lid with a cloth-covered finger, cotton swab or commercial lint-free pad.
3. If your doctor has prescribed an antibiotic ointment, apply a small amount at the base of the lashes using a cotton swab or fingertip. This is generally done at bedtime.

If the blepharitis is not able to be controlled by the above measures, it may be necessary to add one or all of the following medications:

1. Artificial tears may be helpful to relieve dry eye symptoms. These eye drops are available without a prescription.
2. Steroids may be used to decrease inflammation short-term.
3. Antibiotics will be helpful at decreasing bacterial content of the eyelids. In severe cases it may be necessary for long-term use of tetracycline. This medication is taken orally and is routinely used by patients with a skin condition called rosacea.

REMEMBER: To control blepharitis, it is necessary for the patient to actively cleanse the lashes daily by applying warm compresses as described and remembering that medications alone are not adequate.

Thank you to Dr. Ivan Jacobs, our guest blogger today, for sharing his insights and knowledge with us.

Tuesday, June 28, 2011

About Eye Focusing Problems

Myopia is the medical term for near-sightedness, and occurs when light entering the eye focuses in front of the retina instead of directly on it. Individuals with myopia typically see objects that are close well, but have difficulty seeing objects that are far away. It is caused by a cornea that is steeper, or an eye that is longer, than a normal eye. Approximately 30% of people in the United States are near-sighted. Myopia typically starts to appear between ages 8-12, often progresses over childhood, and stabilizes by adulthood.

Hyperopia is the medical term for far-sightedness, and occurs when light entering the eye focuses behind the retina, instead of directly on it. Individuals with hyperopia usually have trouble seeing up close, but may also have difficulty seeing objects far away as well. It is caused by a cornea that is flatter, or an eye that is shorter, than a normal eye. Because young people with mild to moderate hyperopia can often focus their eyes to see clearly, hyperopia is often undetected until later in life, when the eye begins to lose its ability to accommodate.

Astigmatism refers to the shape of the cornea of the eye. A cornea without astigmatism has a spherical shape, like a basketball. A cornea that has astigmatism has a more oval shape, similar to a football. Most astigmatic corneas have two curves – a steeper curve and a flatter curve. This curve causes light to focus on more than one point in the eye, resulting in blurred vision at distance and near. Astigmatism often occurs along with myopia or hyperopia.

Presbyopia is a term that is used to describe an eye in which the natural lens can no longer accommodate. Accommodation is the eye’s way of changing its focusing distance: the lens thickens during accommodation, thereby increasing its focusing power and its ability to see up close. As we age, the lens begins to lose some of its elasticity. This is a gradual process, although to many it appears to occur suddenly (typically around the age of 40). Most people first notice difficulty reading very fine print such as the phone book, a medicine bottle, or the stock market page. They may also have difficulty adjusting their focus from near to far. At first, holding reading material further away helps many patients, but eventually, correction is needed in the form of reading glasses, bifocals or contact lenses. Near-sighted individuals may simply be able to take their glasses off to read.

Options: There are four main options for correcting these refractive errors. These are glasses, contact lenses, refractive surgery or lens implantation. Feel free to discuss any or all of these options with your eye care professional to find out which one may be best for you.

Thank you to Dr. Ivan Jacobs, our guest blogger today, for sharing his insights and knowledge with us.

Thursday, June 23, 2011

Eyelid Spasms–What Causes This?

Are there different types of eyelid spasms?
Yes. The three most common types of eyelid spasms are eyelid twitch (or tic), essential blepharospasm, and hemifacial spasm.

What causes minor eyelid spasms?
The cause of minor eyelid twitching is unknown. A slight spasm of the lower eyelid or even both eyelids is common and of no concern. Minor eyelid twitches require no treatment as they usually resolve spontaneously. Reducing stress, using warm soaks, or correction of any refractive error may help.

What is essential blepharospasm?
Essential blepharospasm is an involuntary condition usually involving both eyes, where the eyelids and, sometimes, the eyebrows close involuntarily. In advanced cases, muscles of the mouth or neck are sometimes involved in these spasms. When these spasms occur, temporary inability to see may result because of the involuntary eyelid closure. These spasms are rare but very troublesome, and often incapacitating.

What causes blepharospasm?
Blepharospasm is caused by abnormal nerve impulses, which produce muscle spasm. It is almost never a psychiatric disease.

How can blepharospasm be treated?
Blepharospasm can be treated with medications, biofeedback, injection of botulinum and surgery. Medications and biofeedback are rarely successful in managing blepharospasm, but may be advised in mild cases or cases not responding to other treatment.

Botulinum injections are now the most commonly recommended treatment for blepharospasm. Injection of botulinum (botulism toxin) in very small quantities into the muscles around the eyes relaxes the spasm. The injection works for several months, but will slowly wear off and usually needs to be repeated.

The treatment is very successful with few side effects. Drooping of the eyelids, double vision or dryness of the eye are possible side effects, but occur rarely and will subside as the injection wears off.

Surgery may also be recommended by your ophthalmologist. The surgeon removes either the nerve causing the spasm or the spastic muscles themselves. The surgical results are generally permanent and any side effects are also usually permanent.

What is hemifacial spasm?
Hemifacial spasm is a condition which involves the eyelid muscles and usually the muscles around the mouth on only one side of the face. Hemifacial spasm is usually caused by an artery pressing on the nerve to the facial muscles, causing the face to twitch. Botulinum injections may be beneficial in relieving the eyelid spasms in patients with hemifacial spasm.

A neurosurgical procedure for hemifacial spasm may relieve the pressure of the artery on the nerve. While it is generally successful, it is a major neurosurgical operation and serious complications are possible.

Thank you to Dr. Milton Kahn, our guest blogger today, for sharing his insights and knowledge with us.

Tuesday, June 21, 2011

About Intraocular Lens Implants (IOL)

Intraocular Lens Implants which are also referred to as Intraocular Lenses or IOLs are tiny artificial lenses that are used to correct vision as part of the Cataract Surgery procedure. IOLs can also be used for certain patients who suffer from presbyopia, a condition in which the crystalline lens of the eye becomes less flexible thus losing its ability to focus on near objects.

Monofocal Lens Implants vs. Multifocal Lens Implants
The traditional lens implants that were used for some 25 years were of a type called Monofocal Lens Implants. As the name implies, Monofocal Lens Implants can only offer patients clear vision at one set distance-usually far away. Today we are able to offer patients vision correction after Cataract Surgery with Multifocal or Accommodating Lens Implants that allow patients to see at a range of distances. This technology allows us to replace the eye’s natural lens with a new, artificial lens that can help restore visual clarity for near, intermediate and distance vision with reduced dependence on eyeglasses and often not requiring them at all.

Astigmatism Correcting Toric Lens Implants
For patients who wore eyeglasses to correct astigmatism before their Cataract Surgery they may still experience blurred and distorted vision after traditional Cataract Surgery because a Monofocal IOL cannot correct astigmatism. To achieve the best quality of distance vision with a traditional IOL may still require glasses, contact lens or further surgery. If freedom from glasses for distance vision is important to you, you now have a better option. “We are now able to implant a special lens implant design called an astigmatism correcting toric lens implant making it possible to reduce or eliminate astigmatism and significantly improve uncorrected distance vision”, said Joel Confino, M.D. “Toric IOLs provide significantly improved distance vision and reduce the need for corrective lenses compared to a traditional Monofocal IOL.”

Aspheric Lens Implants
“Most people do not realize that their eyes have optical distortions-called aberrations-that can cause vision problems”, said Ivan Jacobs, M.D. of Eye Care & Surgery Center.
One type of common aberration is called spherical aberration and is generally associated with vision disturbances including:
• Blurriness
• Halos
• Loss of contrast
• Poor night vision

Today at The Eye Care & Surgery Center we can implant aspheric lens implants that are designed to reduce spherical aberration resulting in increased contrast sensitivity, enhanced clarity and improved image quality especially in dim illumination or low contrast environments such as driving at dusk or on rainy foggy conditions.

Please feel free to contact us with your questions about Cataracts, Cataract Surgery or Lens Implants by calling Eye Care & Surgery Center at 908.789.8999.

Friday, June 17, 2011

Medical Insurance – What to Know?

In today’s world of big insurance companies and small employer groups, understanding your health benefits can be a tough task. I think most of us can agree that deductibles, co-pays and premiums are higher than they have ever been. In order for employers and insurance companies to save money, out of pocket expenses have been passed on to the policy holder.

It is important for patients to understand that their insurance policy is an agreement between the patient and their insurance carrier.

Call them and ask the questions you would like the answers to:

Is the doctor I’m seeing in network?
Do I have any type of deductible?
Do I need a referral for a specialist?
Is this a covered benefit?

These questions can help you avoid unexpected out of pocket expenses. They can also help you utilize your insurance coverage to ensure you get the most from your benefit package. The call should not take too much of your time and it may save you lot of aggravation in the future. Insurance companies have made it easy for patients to find out their coverage. There should be a member services phone number on your insurance card. Ask for the benefit department and they should be able to review your individual policy and give you the answers you are looking for.

From a physician’s office point of view, practices have patients coming in and out all day and see many different insurance cards. They cannot possibly know or be held accountable for every patient’s individual insurance benefits.

A physician’s office will usually submit a claim on your behalf but at the end of the day the patient is the person that will be held accountable for any outstanding balances and non covered services. Make the call, know your insurance and be your own advocate. In the long run you will be glad you did.

Thank you to Judy McCann, Director of Billing at The Eye Care & Surgery Center, our guest blogger today, for sharing her insights and knowledge with us.

Wednesday, June 15, 2011

Chalazia and Styes: Symptoms and Treatment

The term Chalazion comes from a Greek word meaning a small lump. It refers to a swelling in the eyelid caused by inflammation of one of the small oil producing glands (meibomian glands) located in the upper and lower eyelids.

A chalazion is sometimes confused with a stye, which also appears as a lump in the eyelid. A stye is an infection of a lash follicle that forms a red, sore lump near the edge of the eyelid. A chalazion is an inflammatory reaction to trapped oil secretions. It is not caused by bacteria, although the site can become infected by bacteria.
Chalazia tend to occur farther from the edge of the eyelid than styes and tend to "point" toward the inside of the eyelid. Sometimes a chalazion can cause the entire eyelid to swell suddenly, but usually there is a definite tender point. When a chalazion is small and without symptoms, it may disappear on its own. If the chalazion is large, it may cause blurred vision.
Chalazia are treated with any or a combination of the following methods:
1. Warm Compresses and Massage. Warm compresses can be applied in a variety of ways. The simplest way is to hold a clean washcloth, soaked in hot water, against the closed lid. Do this for five to ten minutes, three or four times a day. Repeatedly soak the washcloth in hot water to maintain adequate heat. The majority of chalazia will disappear within a few weeks. An alternative to a moist washcloth, which can get cold too rapidly, is to place a moist paper towel in a zip lock bag, or heat a baked potato, bag of rice, or bag of beans in the microwave oven to heat it, and then wrap a washcloth around the heated object. This is then placed over the affected eyelid after which the chalazion is to be massaged in the direction of the eyelashes.
2. Steroid Injections can be useful after soaks have been tried and a small lump remains.
3. Surgical Incision or Excision of large chalazia, which do not respond to other treatments, can be surgically opened after the early inflammation is reduced.
Chalazia usually respond well to treatment, although some people are prone to recurrences. If a chalazion recurs in the same place, your ophthalmologist may suggest a biopsy to rule out more serious problems.

Thank you to Dr. Chris Thiagarajah, Cosmetic Eye Plastic & Reconstructive Surgeon at The Eye Care & Surgery Center, for sharing his insights and knowledge with us.

Thursday, June 9, 2011

Glaucoma with Cataracts: Can I Treat Both?

Endoscopic Cyclophotocoagulation (ECP) & Cataract Surgery
The treatment of coexisting cataract and glaucoma is a complex issue. For some patients who have this combined problem, cataract extraction combined with ECP is our procedure of choice.

Simultaneous Cataract and ECP Surgery could allow you to improve your vision while reducing, or completely eliminating your dependence on Glaucoma medications. Each of these surgical procedures lasts only a few minutes, using highly refined, minimally invasive, surgical techniques and state of the art instrumentation. ECP is a surgical technique that inhibits the production of aqueous in the eye, typically resulting in a decrease in intraocular pressure and the reduction or elimination of a patient's dependence on glaucoma medications. Simultaneous Cataract & ECP Glaucoma Surgery is also convenient, typically reducing the frequency, number and costs of glaucoma medications for patients, and requiring no more follow-up visits than for cataract surgery alone.

The ECP procedure is performed using a state-of-the art laser microendoscope. Endoscopy, which allows surgeons to view and treat internal structures through a small incision, (as in Arthroscopic knee surgery for example), has revolutionized minimally invasive surgery, affording patients quicker and more comfortable recoveries along with improved and more predictable outcomes. The microendoscope chosen for our facility is a unique instrument. It is about the diameter of a small paper clip, the smallest medical endoscope developed to date.

It utilizes an integrated imaging and laser fiberoptic bundle to allow simultaneous viewing and highly targeted treatment of the surface cells of the ciliary processes. The ciliary processes are a series of organs located below the base of the underside of the iris which exude aqueous fluid into the eye.

During combined cataract and ECP glaucoma surgery the laser microendoscope is introduced through a small incision already made during the cataract procedure. Both surgeries are performed under local anesthesia on an out patient basis.

While there are other surgical options to treat glaucoma, ECP is offered because it provides the following:

• Excellent Safety Record
• Predictable, Improved Outcomes
• Uncomplicated Follow-Up
• Fast Recovery

ECP can also be performed without simultaneous cataract surgery. Pre-emptive to glaucoma filtering surgery, ECP in conjunction with SLT (Selective Laser Trabeculoplasty), may be used in an attempt to better control glaucoma and improve pressure lowering of glaucoma without more invasive and dangerous surgery. However, if the ECP still fails to control the glaucoma, then standard glaucoma surgery may still be performed.

Thank you to Dr. Ivan Jacobs, our guest blogger today, for sharing his insights and knowledge with us.

Tuesday, June 7, 2011

New Jersey Cataract Awareness Month

Eye Care and Surgery Center wishes to announce that Prevent Blindness America has designated June as National Cataract Awareness Month. Cataracts are the leading cause of blindness worldwide. About 20.5 million Americans age 40 and older have cataracts and more than half of all Americans develop cataracts by age 80.

“Many patients do not actually know that a cataract is a clouding of the crystalline lens of the eye preventing light rays from passing through it easily. This results in a clouding and blurring of vision”, said Joel Confino, M.D. a Cornea, LASIK and Cataract Surgeon at Eye Care & Surgery Center. “We want them to understand that cataracts are not a growth or a film over the eye.”

For many patients cataracts start out slowly and have little effect on vision at first. But, as the cataract becomes denser, so does the impact on vision. The most common symptoms that bother patients with cataracts include:

• blurring of vision
• sensitivity to light and glare
• double vision in one eye
• poor night vision
• fading or yellowing of colors
• frequent changes in glasses or contact lens prescriptions.

When cataracts do begin to interfere with daily activities or with patient comfort and safety, they can be treated surgically. Cataract surgery is one of the safest and most frequently performed surgeries in the United States. Today, at The Eye Care & Surgery Center we have a full range of Intraocular Lens Implants (IOL) available that allow us to correct near vision as well as distance vision without requiring bifocals or reading glasses for the vast majority of patients. Please feel free to contact us with your questions about Cataracts, Cataract Surgery or Lens Implants by calling Eye Care & Surgery Center at 908.789.8999.

Thursday, May 26, 2011

Non-Surgical & Liquid Face-Lifts

Poly-L-lactic acid (PLLA) is a biodegradable material that has been used medically for years in many forms such as absorbable sutures, plates and screws. PLLA, under the name New Fill, has been on the market in Europe since 1999 as an injectable volumizer for improvement of facial loss in HIV patients. In the United States, PLLA gained FDA approval for treatment of HIV related facial lipoatrophy in 2004. Though initially approved for use in HIV patients with facial fat loss, PLLA treatment has been also used on an off label basis for cosmetic patients. Fat loss or redistribution is the primary reason for thinning of the face in people as they get older. In July 2009, PLLA treatment was approved by the FDA cosmetically for nasolabial folds. The cosmetic PLLA product is now marketed and available to the public.

Mechanism of Action
PLLA consists of microspheres of a synthetic polymer. The microspheres are less than one micron in diameter and create a reaction that leads to growth of collagen. Studies have shown that after injection into the soft tissue, the microspheres degrade over time into carbon dioxide and water while causing stimulation of type I collagen growth. Imaging studies have shown a threefold increase in skin thickness sustained at 96 weeks. At 9 months PLLA completely disappears and is replaced by collagen. The effects of PLLA treatment have been documented in the Vega, Westminster, Blue Pacific and Apex trials to have lasting results over 24 months. More recent studies have shown the increase in skin thickness to last up to 40 months.

Thank you to Dr. Chris Thiagarajah, our guest blogger today, for sharing his insights and knowledge with us.

Tuesday, May 24, 2011

LASIK: What Are The Long Term Results?

Many people ask about the long-term benefit of LASIK, and how it will impact their eyes as they age. The general consensus (and my personal experience) is that most well-selected candidates with stable vision will retain their improved vision for many years. It is known that the reading vision changes with age and as patients of mine over the last 20 years have moved into their 40’s and beyond, they have required assistance with their near vision, usually in the form of reading glasses. I anticipate that there will be effective alternatives for near vision, such as the implant of a small device in the cornea to allow for reading vision while preserving distance vision. This has been introduced in Asia and Europe and looks promising.

There is also the advent of the use of multifocal lenses implanted into the eye to replace the natural lens. At The Eye Care and Surgery Center, we have had a very successful experience with this in our older patients who can become glasses-free as a result. Initially this was performed only in cataract patients, but we are now using these in selected patients in their 50’s and beyond as a valid method of vision correction.

Stay tuned for further advances!

Thank you to Dr. Joel Confino, our guest blogger today, for sharing his insights and knowledge with us.

Thursday, May 19, 2011

Glasses after Cataract Surgery-Will I Need Them?

Ivan Jacobs, M.D.

“As a Cataract Surgeon I have two main goals to achieve during Cataract Surgery. First, I want to remove the cloudy crystalline lens. The crystalline lens is actually an optical component of the eye that provides focusing power. Second, I want to replace the optical and focusing power that was provided by crystalline lens by implanting an intraocular lens (IOL) to provide the correct amount of focusing power to allow you to see clearly”, stated Ivan Jacobs, M.D. of The Eye Care & Surgery Center.

Joel Confino, M.D.

“Before you developed a Cataract, if you wore glasses because you were nearsighted, farsighted or had astigmatism it is now possible for us to use a carefully calculated IOL power or special IOL that can correct astigmatism so that you may not need to wear eyeglasses to see at distance after your surgery”, commented Joel Confino, M.D. “Today, it is even possible for us to select IOLs that can correct both distance and near vision so that you can decrease or even eliminate your dependence on bifocals and reading glasses after your Cataract Surgery.”

If you think you have a Cataract or have been told you have a Cataract and would like to be less dependent on glasses it is worthwhile to schedule an appointment at The Eye Care & Surgery Center to discuss advanced technology intraocular lens implants so that we can guide you as you learn about your possibilities and options for vision correction after Cataract Surgery. Please call Eye Care & Surgery Center at 908.789.8999.