Crystalens for Cataract Surgery

Quick facts on Crystalens®
During cataract surgery the cloudy cataractous lens is replaced with a clear artificial lens (implant). Many patients with cataracts are candidates for a flexible implant that can focus both at distance and near to reduce or eliminate the need for reading glasses.
Patients who are good candidates for standard monofocal IOLs are typically good candidates for Crystalens. If a patient has healthy eyes, has not had previous cataract surgery, and does not suffer from any major health problems, then he or she is likely to be a good candidate.
More than twice the number of patients implanted with Crystalens could see well at all distances compared to a standard IOL.
Most Crystalens patients have reduced their dependence on glasses and are able to read the newspaper or a phone book without glasses.
Most Crystalens patients are able to see their computers, dashboards and anything else at arm’s length without glasses.
Most Crystalens patients are able to see 20/40 or better after surgery, so the clock across the room and the TV in the corner are clearly within sight.
Many of our Crystalens patients can see well enough to do away with their reading glasses, bifocals, or contact lenses. The Crystalens procedure is highly successful and most people regain very good distance vision, somewhere between 20/20 and 20/40.

Custom LASIK Does Not Equal CustomVue

Raleigh area LASIK candidates can be confused by advertisements for “custom LASIK”. Patients considering LASIK and who understand that the results of custom LASIK are in general, better than conventional LASIK, may mistakenly believe that all providers who offer custom LASIK are offering the same service.
Unfortunately, some providers of wavefront optimized LASIK advertise their procedure as “custom”. This is a distortion of the original meaning of custom LASIK which refers to wavefront guided LASIK.
Needless to say, the visual performance of wavefront guided LASIK tends to be better than wavefront optimized. This has been born out by numerous studies and is the reason that NASA and the Department of Defense prefers wavefront guided LASIK.
Vision problems can be categorized into lower order ones (nearsightedness, farsightedness and astigmatism) and higher order aberrations: the type that cause visual distortions, night time halos and starbursts. Wavefront optimized LASIK simply means there is an effort made not to induce new aberrations. Wavefront guided LASIK means that there is an effort to correct any preexisting distortions /aberrations and is the reason some LASIK patients will note that there vision is actually better after LASIK than it was before with their best glasses or contact lenses.
Raleigh area LASIK candidates may want to investigate data submitted to the FDA on LASIK. They will discover that the LASIK technology with the highest ever rate of 20/20 results was accomplished by CustomVue on a VISX Star laser and is the same technology employed here at the Laser Eye Center of Carolina.

Crystalens HD

The Crystalens HD is a fourth generation accomodating implant used during cataract surgery. It gives a better range of focus than previous models. The Crystalens implant is the only IOL of its kind approved by the FDA. Because it is flexible, patients are able to see both distance and near without the need for eyeglasses. As time goes on, I expect to see even better models with a still wider range of focus. See http://www.crystalens.com for more information.

Premium IOLs in Europe

In what may appear to be contradictory facts, European patients have more choices of premium intraocular lenses to be used in their cataract surgery but fewer than 10% actually end up getting them.
There are more choices because the implants can be brought to market sooner with fewer regulations. Some of the implants currently being reviewed by our FDA are already being used in Europe.
But...because of the restrictive health care system, many of these implants are available only to patients who get their care outside of government provided health care. This is because many of the plans do not allow doctors additional compensation for the additional time and expense involved in providing these implants. They are even forbidden to attempt to collect any additional fees from the patient. This is a tremendous disincentive to providing these lenses. Why would a doctor take on the additional expense and spend additional time and still be reimbursed the same?
Likewise, hospitals and ASCs may be reimbursed a set fee for cataract surgery that include the cost of the implant. Hard strapped facilities would find it hard to justify providing a more expensive , premium product and still be reimbursed the same.
Fortunately, in our country, doctors and facilities are able to recoup the additional expense involved in providing these implants. As time goes on, more and more patients are choosing these implants as a means to reduce their dependence on glasses and that's worth something isn't it?

More Evidence of the Benefits of LASIK

An article in the April issue of the Journal "Ophthalmology" highlights the benefits of new LASIK technology. The article described visual performance in simulated night driving conditions using two different LASIK technologies. One group of patients had conventional LASIK with a microkeratome the other group of patients had an all-laser Wafefront guided LASIK (custom, femtosecond flap)
The authors concluded that Wavefront-guided LASIK to correct myopia combined with a femtosecond laser flap significantly improved mean night driving visual performance and was significantly better than conventional LASIK using a mechanical keratome.
Potential LASIK patients may want to educate themselves on the distinction between different LASIK technologies to insure the best outcome. Think twice before trusting your eyes to a LASIK discounter who advertises a bare bones "out the door" price.
I can help you sort through the maze of articles and different studies. Readers are welcome to come in for a free LASIK consult. We even offer convenient evening hours. Concerned about cost? We participate in all insurance LASIK programs and offer interest free financing for up to 24 months.
Abstract of the article available by clicking on the link.
http://www.ophsource.org/periodicals/ophtha/article/S0161-6420(08)01338-9/abstract

Glaucoma and Alzheimer's Disease

Open-angle glaucoma patients are at an increased risk of developing Alzheimer's disease over time, a review of 12 years of Medicare claims found.
Researchers presented their findings at the Association for Research in Vision and Ophthalmology meeting recently. To come to their conclusion, the investigators followed a group of glaucoma patients and compared them to a similar group of patients without glaucoma. The glaucoma patients were much more likely to eventually develop Alzheimer's disease.
http://www.osnsupersite.com/view.aspx?rid=39524

Changing Eye Color

An ophthalmologist in Panama is currently implanting a colored implant in patients to change eye color. The cost is approximately $8000 plus airfare and accommodations. These implants may be of value to patients with albinism (lack of color) but patients who are receiving these for purely cosmetic reasons are cautioned about potential long term side effects. The lenses have the potential to cause cataract, glaucoma, corneal decompensation, infection and irreversible blindness. They are currently not approved for use in the US.

Changes in Corneal Thickness after LASIK and PRK

Correcting vision by LASIK or PRK involves removal of corneal tissue. Therefore, the cornea is thinner after the procedure than before. Investigators in Denmark wanted to study what happens to the cornea in the months after refractive surgery. They followed patients for 36 months after LASIK or PRK and found a thickening in both the top (epithelial) layer and deeper (stromal) layers in the months after refractive surgery. Doctors and patients can feel more at ease knowing that the cornea does not continue to thin in later years after LASIK.

Preexisting Psychiatric and Personality Disorders Can be a Major Source of Dissatisfaction After LASIK

A recent study done at the US Navy Refractive Center in San Diego was performed to determine the source of patient dissatisfaction after LASIK. The study confirmed that the overwhelming majority of patients were satisfied with the results of their LASIK surgery. An important predictor of dissatisfaction was the preexistence of psychiatric and personality disorders. Specifically mentioned was the presence of depression or a negative outlook. This study points out the importance of screening patients for these disorders and for patients to have realistic expectations. http://www.medpagetoday.com/MeetingCoverage/AAO/7323

Measurement of Depth of Intacs

A recent article explores the use of Intacs in keratoconus:

Measurement of Depth of Intacs Implanted Via Femtosecond Laser Using Pentacam
Journal of Refractive Surgery Vol. 25 No. 4 April 2009

Günhal Kamburoglu, MD; Aylin Ertan, MD and Osman Saraçbasi, PhD

Thirty-two eyes of 23 keratoconic patients receiving Intacs intrastromal corneal ring segments implanted by femtosecond laser were included in the study. The depth of intracorneal channel and Intacs segments were measured for 7 predetermined points at 1 week and 1 year postoperatively using Scheimpflug images.
Mean achieved intrastromal channel depth exceeded the intended parameter by 6.5 µm to 69.0 µm. The standard deviation varied between ±13.5 µm and ±44.2 µm. The segment depth decreased at the end of the first postoperative year in all measured points, and the change was statistically significant at the superior, inferior, and temporal sides of the Intacs. The degree of change was not correlated with size of the Intacs, preoperative central corneal thickness, and mean keratometric values.

CONCLUSIONS
Intacs started out deeper than intended and tended to shallow over time. I had one patient who had erosion of their Intac segment into their anterior chamber which may have been a result of deeper than intended placement. This study has important implications for surgeons who perform Intacs in the treatment of keratoconus.

Ride for the Cure Today

Today (Sunday) we are helping sponsor Ride for the Cure. The motorcycle ride begins at C and C Cycles and ends at Scooters Bar and Grill. http://rideforthecure.us for more info. Hope you can join us in helping find a cure for breast cancer. Next week we will be involved in the Fallen Heroes Run. More info to follow.

Treating Epithelial Ingrowth with the YAG Laser

Jorge L. Alió, MD described the use of the YAG laser to treat epithelial ingrowth after LASIK as an alternative to flap lifts in a recent issue of Refractive Eyecare. Early treatment of mild-to-moderate epithelial ingrowth with the Nd:YAG laser promises a simple way to eliminate a vexing problem and, possibly, prevent the development of more serious problems.
Instead of lifting the LASIK flap, refractive surgeons can treat most moderate epithelial ingrowth and restore patients’ lost visual acuity with a laser commonly used after cataract surgery. This low-energy, effective procedure uses the workhorse of ophthalmic lasers to spare patients more invasive surgery and avoid the risks of further complications from a flap lift

Thin Corneas Not a Risk for LASIK

Contrary to the assumption that eyes with thin corneas are poor candidates for LASIK because they are at increased risk of developing postoperative ectasia, scientific evidence fails to support preoperative central corneal thickness (CCT) as an independent risk factor for this complication, said William B. Trattler, MD, at the annual meeting of the American Academy of Ophthalmology. Individuals with thin corneas, however, are at risk for ectasia if an abnormality such as forme fruste keratoconus (FFKC) is found during preoperative topographic analysis, he said.
Time and time again I have seen patients told they are not a candidate for LASIK because of thin corneas. There are multiple studies that show that thin corneas are not an independent risk factor for LASIK and this is just one more report confirming this.

Outdoor Activities Decrease the Risk of Myopia

Spending 2 to 3 hours a day outdoors can significantly lower a child’s risk of developing myopia, according to a new study.
A child’s chances of becoming nearsighted, if he or she has two nearsighted parents, are about six in 10 for children who spend 0 to 5 hours outside a week, but the risk drops to two in 10 when outdoor time exceeds 14 hours a week, according to researchers.
Researchers also said that the critical factor for reducing development of myopia in children seems to be total time spent outdoors; both active and passive outdoor activities equally protected child’s vision.

Botox

Speaking of newer cosmetic uses of drugs, many readers may not be aware that the some of the original uses of Botox also were in ophthalmology. The muscle paralyzing properties were and continue to be used in blepharospasm, a benign but very disturbing forceful lid closing condition. Patients who suffer from blepharospasm experience uncontrolled forceful lid closure/spasms that can be quite debilitating. The injection of botox in and around the eyelids can give relief for approximately 6 months. Now the most common use of Botox is the relaxation of facial wrinkles. Newer indications continue to evolve and Botox has been used for relief of other muscle spasms and contractions, strabismus, severe sweating (hyperhidrosis), and headaches.

New Drug for Longer Lashes

Doctors are always looking for new uses for existing drugs. What started out as a medication for a very serious eye problem is now making waves as the latest thing in cosmetics. It can make eyelashes longer & thicker.
Latisse contains bimatoprost, a compound from a glaucoma drug called Lumigan. It binds to receptors in the eyelashes that may be involved in the development and re-growth of hair follicles. Allergan has used bimatoprost since 2001 in Lumigan.
The company began studying the potential of using a lower dose of topical bimatoprost to stimulate eyelash growth after Lumigan users developed unusually lush lashes. It's specifically being marketed as a once-a-day medication to treat eyelash hypotrichosis, or lack of hair growth.
Latisse pushes more follicles into the growth phase, and lengthens the time they spend there. But you do need to be careful applying Latisse.
If it gets on other skin, it can cause discoloration.
And some users in the trial reported redness, or itching of the eyes.
The drug's effect isn't immediate. According to manufacturer Allergan, the drug usually brings results two to four months after users start it.
Latisse has been on the market for about two weeks now... And it's generated a lot of interest.
But it isn't cheap. It costs about $240 dollars for a year's supply. And you have to keep using it to keep your lashes full.
It's possible that the drug may also spur eyebrow and scalp hair growth, doctors told the Wall Street Journal. But Allergan spokesperson Heather Katt says the company hasn't explored using Latisse for those purposes

New Bifocal Intraocular Lens

One of the main complaints that patients have had with the Alcon ReStor Intraocular Lens was the close working distance and poor intermediate vision found with this lens. The near focal point of this implant is around 13 inches which forced patients to hold reading material much closer than they may have been accustomed to. This lens also did not perform well at the computer or when used for other intermediate tasks such as looking at prices on store shelves etc. Alcon has addressed these problems with a new model ReStor which has a near focal length of approximately 16 inches. In the recent FDA clinical trial of the AcrySof IQ Restor IOL +3.0 D (Alcon Laboratories, Inc., Fort Worth, TX), patients achieved the same superb distance and near vision with this lens as those who received the AcrySof IQ Restor +4.0 D lens (Alcon Laboratories, Inc.). As an added benefit, compared with the +4.0 D model, the +3.0 D design dramatically improved patients' intermediate vision at 50, 60, and 70 cm .

Intacs for Keratoconus

Keratoconus is a corneal disorder in which progressive astigmatism develops, probably because of weakening. Patients who suffer from keratoconus suffer from corneal thinning and vision loss. Ultimately patients may require a corneal transplant. Recently, surgeons have begun to implant plastic inserts (Intacs) to bolster the cornea and delay, perhaps indefinitely, the need for a corneal transplant. I have implanted Intacs in several keratoconus patients and have been impressed with the results. Patients have exhibited a reversal in their astigmatism and often show an improvement in best corrected vision. the original application for Intacs was for the correction of nearsightedness. Popularity has waned as the LASIK procedure improved but Intacs have enjoyed a resurrgence in interest for their use in keratoconus. For more information go to www.intacsforkeratoconus.com.

Toric implants for astigmatism

Patients contemplating cataract surgery will have the choice of correcting their astigmatism with a newer implant developed by Alcon. The idea of the implant is to correct their astigmatism at the time of their surgery thus getting a "two for one" benefit. If you have astigmatism, ask your surgeon if this implant would be a good idea for you.