Eye-Openers

Cutting-edge treatments available for cataracts, glaucoma, dry eye.

In high school, Louis Carrino worked as a de facto apprentice to a pharmacist filling prescriptions. While employed in the pharmacy, Louis became acquainted with several pharmaceutical sales representatives. Those relationships triggered an interest that turned into a vocation.

Photo by Nerissa Johnson.

Louis Carrino

“In college, I decided that instead of going into education, I would pursue a career in pharmaceuticals,” the Syracuse, New York, native details. “In my entry-level position at Aires Pharmaceuticals, I worked in the field calling on physicians and learned more about the medications. I also received in-house training.

“Over time, opportunities arose within the company to do research and development on new products as well as new indications for existing products. So, I became a multitasker. I called on physicians and wholesalers to store and stock medications, and I worked with physicians at Upstate Medical Center doing studies on new drugs.”

For more than 60 years, Louis wore hard contact lenses to correct his vision, which hovered around 20/200. The contacts sometimes bothered Louis’ eyes, often making them dry. But over time, Louis developed more serious eye issues that threatened his eyesight.

“About 10 years ago, my ophthalmologist told me I was developing cataracts and said they would get worse over time,” recalls Louis, 79. “I recently reached a point where my vision wasn’t as good as it used to be, even though I was increasing the strength of my contacts. I also became uncomfortable with nighttime driving due to halos and glare from oncoming headlights.”

Cataracts are the clouding of the normally clear natural lens of the eye, most often due to aging. They are treated with cataract surgery during which the cloudy natural lens is removed and replaced with a clear, artificial replacement lens called an intraocular lens, or IOL.

Complicating matters, Louis also lives with glaucoma, a disease that can damage the optic nerve and lead to vision loss. Glaucoma is most often caused by an abnormal increase in fluid pressure inside the eye.

“I’ve had glaucoma for years,” Louis shares. “My previous physician was pretty relaxed about treating it, but then the pressure in my eyes became a big problem. Eventually, I was put on several medications to control the pressure.”

To Louis, the thought of losing his vision to cataracts and glaucoma was scary. A few months ago, he resolved to seek treatment.

“The ophthalmologist I was seeing had to step down for medical reasons, and that’s when I met Dr. Brown,” Louis relates. “Immediately, I felt confident in her and her medical training. We had a long discussion about my condition and decided now was the best time for surgery.”

Helayna Brown, MD, is a cataract surgeon at The Dry Eye Spa & V.I.P. Laser Eye Center. She developed a treatment plan after noting Louis’ complaints of blurry vision, trouble reading and difficulty seeing objects.

“Louis had visually significant cataracts with substantial corneal astigmatism in both eyes,” Dr. Brown reports. “He also had progressive glaucoma in both eyes and was using four pressure-lowering eyedrops to control his eye pressure and prevent his glaucoma from progressing.

“I recommended cataract surgery with toric IOLs to correct his astigmatism so he could have distance vision without glasses. For his glaucoma, I recommended XEN® gel stents, microscopic stents that are implanted during minimally invasive glaucoma surgery (MIGS), a brief add-on procedure performed at the conclusion of cataract surgery.”

A Hair’s Breadth

XEN gel stents are for patients with open-angle glaucoma that is not responding to medication or patients who cannot tolerate glaucoma eyedrops. Open-angle glaucoma is caused by the gradual obstruction of the fluid drainage channels inside the eye (trabecular meshwork), which leads to an increase in pressure. It affects 99 percent of glaucoma patients.

Photo by Nerissa Johnson.

After combination cataract and glaucoma surgery, Louis can see clearly when working with the rescue dogs.

“The XEN is about 6 mm long, or the size of an eyelash,” Dr. Brown describes. “During MIGS, the XEN is inserted into the eye and it is tunneled under the conjunctiva, the clear membrane covering the white part of the eye. The XEN allows fluid to flow from the anterior chamber of the eye through an alternative pathway to the blocked trabecular meshwork, thus lowering eye pressure.

“Louis’ outcome following surgery was excellent. Prior to surgery, he was using four eyedrops to maintain his eye pressure in the low teens. After surgery, his eye pressure was between 9 and 11 with no eyedrops. With eye pressure that low, his glaucoma is unlikely to progress.”

Intraocular pressure is measured in millimeters of mercury, with a normal range of 10 to 21, according to the American Academy of Ophthalmology.

Grains of Sand

Like Louis, Laurie Woolwine considers her job a vocation. She’s a mental health counselor and marriage and family therapist in private practice. Before venturing out on her own, Laurie served as an addiction counselor at a substance abuse treatment center.

Laurie wanted to work in psychology and mental health since high school. While completing her graduate education, she developed a special interest in the neuroscience of mental health.

“That involves gaining an understanding of the brain and how its neurochemicals affect how a person feels, then integrating that information into therapy,” Laurie explains. “I help people understand how their brains’ neurotransmitters correlate to their situation, so if they are prescribed medication, or if they have a problem with drinking or another addiction, the reasons for that make more sense to them.”

Photo by Nerissa Johnson.

Laurie Woolwine

Laurie, a Virginia native, is married to an airline pilot who retired from the Air Force. The couple lived in cities across the country while he was on active duty, then settled in Florida in 2000.

“We chose Florida for the climate,” Laurie admits. “We wanted nice, warm weather and my husband can fly out of Miami. We chose to live in Wellington because we wanted a family community for our kids.”

But not even the warm weather and friendly neighborhood could alleviate the terribly uncomfortable eye symptoms Laurie began to experience around 2010.

“My eyes became extremely light sensitive, painful and dry, like there was sand in them or a fan was blowing on them all the time,” she describes. “Even in the rain I had to wear sunglasses, and I couldn’t have lights on. I couldn’t go to the beach if it was a really sunny day. When I walked to the mailbox, I had to wear sunglasses and cover my eyes on top of that.

“It got to the point where I couldn’t drive. One day, I almost got into an accident because I couldn’t hold my eyelids open due to the pain. I had to pull over to the side of the road. And the situation wasn’t getting better.

“I tried all of the over-the-counter remedies for dry eyes, but they didn’t work. I went to lots of different eye doctors trying to get help for my eyes. They provided a little relief, but I was never really comfortable.”

Then, a colleague showed Laurie a copy of Florida Health Care News. In it was an article about Clifford L. Salinger, MD, founder of The Dry Eye Spa & V.I.P. Laser Eye Center. After reading the article, Laurie made an appointment to see Dr. Salinger.

Laurie made her first visit to The Dry Eye Spa & V.I.P. Laser Eye Center in December, 2017 and Dr. Salinger diagnosed her with dry eye disease and Meibomian gland dysfunction, a condition in which the oil glands in the eyelids become blocked with thickened material.

“Water and oil are the two most important components of the tear layer,” Dr. Salinger explains. “Without oil, the tear layer is much more unstable. It does not stay evenly spread over the surface of the eye and evaporates more quickly. This causes dry eyes and fluctuating vision, which is what I found with Mrs. Woolwine.”

“So we started her on our multi-treatment protocol that includes anti-inflammatory steroid eyedrops, RESTASIS®, hot compresses, lid cleaning, vitamin supplements and an antibiotic drop applied to the eyelids to encourage the oil glands to flow freely. That resulted in some improvement in her condition but not enough to relieve her symptoms to any great degree.

“So early the next year, we presented her with the idea of treatment with LipiFlow®. She agreed and we performed the treatment.”

LipiFlow’s Three Steps

The LipiFlow Thermal Pulsation System from TearScience® combines the controlled application of therapeutic heat with a gentle, pulsating massage. These functions work to liquefy, then remove clogging debris from the eyelid glands, enabling them to function efficiently.

“LipiFlow is a revolutionary breakthrough for treating chronic dry eye disease,” Dr. Salinger asserts. “It relieves dry eye symptoms by removing blockages of the eyelids’ oil glands. Opening and clearing the blocked glands enhances the natural production of the oils needed to restore a healthier tear layer on the surface of the eye.

“In our practice, the LipiFlow treatment is a three-step process. First, we thoroughly deep clean the lids. Then, we apply the LipiFlow device to the eyes. The device fits over the eye but does not touch the eye itself. The heating element is in contact with the underside of the eyelid, which works because the oil glands lie deep in the eyelids and the heat from the device is applied directly to them.”

The third step is an expression of the oil glands by the doctor immediately after the LipiFlow while the gland material is still warm and relatively viscous. This step is done to remove any clogging material the LipiFlow may have left behind.

“About 90 percent of individuals report significant improvement in their symptoms following this three-step process,” Dr. Salinger notes. “Of those 90 percent, approximately half report measurable improvement at one month following LipiFlow. The other half can take two or three months to feel the benefits, and there’s a very small percentage that take up to four to six months to experience the benefits.

“During the first few months following Mrs. Woolwine’s LipiFlow treatment, we were able to taper back on her treatment protocol and we discontinued her steroid eyedrops completely. She is now being maintained on hot compresses, lid cleaning and cyclosporine drops, and she has experienced significant improvement in her dry eye symptoms.”

Life-Changing Care

Laurie underwent the LipiFlow process two years ago, and she’s still reaping benefits today.

Photo by Nerissa Johnson.

After treatment with the LipiFlow System, Laurie’s eyes are less dry and driving is easy again.

“The LipiFlow treatment was life-changing for me,” she enthuses. “Now I don’t have any pain in my eyes, and I don’t have to wear sunglasses just to open them. I don’t have to stare at the ground when I go outside. I can tolerate wearing my contact lenses, and I can work out, drive and go to the beach with my family.

“Since I had the LipiFlow treatment, I don’t have to use all of the other treatments I used before. I’m just following a few basic protocols that Dr. Salinger recommended. And I visit Dr. Salinger every four months to make sure my eyes continue doing well.”

Like Laurie, Louis is pleased with the results of his treatment.

“Before Dr. Brown’s surgery, I was using several different drops to control the pressure in my eyes from the glaucoma,” he recounts. “Since surgery, all of those medications have been discontinued. My vision now is excellent, 20/25. And I don’t wear contacts anymore. With the lens implants Dr. Brown used, I can see in the distance clearly. I can make out the words on the TV as words instead of blurred letters.

“Dr. Brown is super and very likeable,” Louis adds. “She’s very knowledgeable and dependable, and I’m very impressed with her. That’s the reason I agreed to have surgery with her. And I’m 110 percent happy with my outcome!”

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