Hitting a Trifecta

Trio of eye procedures corrects vision, relieves symptoms.

Like the sports cars he tinkers with, Charles Boggess, 61, has a few parts that aren’t original. The 61-year-old Florida native and tractor-trailer driver was given a new kidney in 1998. Sixteen years later, he received two corneal transplants to correct a series of problems that began years earlier.

Photo by Jordan Pysz.

Charles is seeing clearly under the hood.

“I started using reading glasses when I was pretty young,” Charles relates. “And I’ve worn regular eyeglasses for nearsightedness since I was thirty. Around 2014, my vision became really blurry. I kept getting new glasses prescriptions, but they didn’t clear up my vision. I eventually went to a new eye doctor, and he figured out I had Fuchs’ dystrophy.”

Fuchs’ dystrophy is a condition that causes the cornea, the clear, protective outer layer of the eye, to swell and become cloudy. In a healthy eye, the cells of the cornea’s endothelial layer pump fluid away from the cornea to keep it clear. With Fuchs’ dystrophy, this layer changes and fails, and fluid builds up, causing hazy vision and eye discomfort.

“It was like living underneath the water, like the filters in my eyes quit working,” Charles describes. “Everything was very blurry. The doctor told me whatever glasses I got weren’t going to work until I got my Fuchs’ dystrophy cleared up. I went to the eye center in Stuart, and the doctor referred me to Dr. Salinger.”

Clifford L. Salinger, MD, a cornea specialist, is the founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens. Dr. Salinger has expertise in treating Fuchs’ dystrophy using partial thickness corneal transplants. That’s what he used to treat Charles’ diseased corneas. Charles was immediately impressed when he met Dr. Salinger.

“I really liked Dr. Salinger,” Charles states, “especially when I learned he flies to different countries to teach doctors how to do the special corneal transplants he performs. He has to be pretty good at the procedure to do that.”

“The partial thickness corneal transplant procedure we perform is called Descemet stripping automated endothelial keratoplasty, or DSAEK,” Dr. Salinger reports. “This is a newer, more advanced method of performing a corneal transplant that involves removing and replacing only the inner lining of the cornea.

“Because it involves transplanting just the inner corneal lining, DSAEK is safer than traditional corneal transplants. There is less trauma to the cornea, so there are fewer risks associated with DSAEK. Healing is faster, and patients have fewer limitations to their lifestyle after the procedure.”

Dr. Salinger performed a DSAEK on Charles’ right eye in September 2014. He performed the surgery on Charles’ left eye in December of that same year. Afterward, Charles gained excellent distance vision in his right eye, but not so in his left eye.

“After the transplant surgeries, I could see very well in the distance with my right eye, but I had quite a bit of astigmatism in my left eye and still couldn’t see in the distance,” Charles shares. “Distance vision is very important for a truck driver, so Dr. Salinger recommended another procedure to correct the astigmatism in my left eye to improve its distance vision. Another reason I wanted both eyes corrected for distance was to keep from having to wear glasses all the time.”

Photo by Jordan Pysz.

Charles Boggess

LASEK with an “E”

“There’s a misconception that if people still need to wear glasses following surgery, whether it’s cataract surgery or DSAEK, they are stuck wearing glasses forever,”

Dr. Salinger notes. “That’s a myth. There are many things we can do, including laser vision correction procedures, that minimize or eliminate dependence on glasses.”

Generally, when people think about laser vision correction procedures, LASIK® laser surgery comes to mind. LASIK corrects vision by reshaping the cornea, which changes its focusing power on the retina, the light-sensitive tissue at the back of the eye.

During LASIK, surgeons use a laser to create a thin flap on the corneal surface. Then, the laser removes some of the tissue underneath the flap to reshape the cornea.

But that’s not the procedure Dr. Salinger selected for Charles. Instead, he chose another laser surgery with a slower healing process that he determined would be better and safer for Charles’ left eye.

“Mr. Boggess was looking to become less dependent on glasses,” Dr. Salinger asserts. “Since he had Fuchs’ dystrophy and underwent previous cornea surgery with the DSAEK, we concluded a procedure without a flap called LASEK, also known as PRK, was the better option for him.”

“When performing LASEK, we first remove the cornea’s surface skin layer, the epithelium, then we apply the laser to the corneal surface. There’s no cutting, no flap,” Dr. Salinger verifies. “We place a bandage contact lens on the eye for better comfort and to assist in healing. The cornea’s skin layer then needs time to heal, but it heals more slowly than it does with LASIK.

“Typically, the eye surface heals within a week after surgery. The bandage contact lens is then removed and vision continues to improve for weeks to months following the procedure. For Charles, LASEK was safer in the short term and the long term.

“It was essential for Mr. Boggess’ professional life that we perform the laser vision correction to balance his two eyes for distance. If we didn’t, he would feel unsafe on the road, and that feeling would be worse at night and in bad weather. That’s definitely not a good scenario for a truck driver.”

Tear-Stained Cheeks

Veteran registered nurse Sharon Piergeorge, 65, jokingly suggests that her desire to work in the medical field was governed by genetics. She says it was passed down to her through her parents.

Photo by Jordan Pysz.

Sharon and her Golden
Retriever, Dunlop, “paws” between
their visits to area medical centers.

“My dad was a physician, and my mom was a nurse, so I think I inherited my interest in nursing from them,” Sharon affirms. “I worked as a nurse for a long time, and I still keep my license active, even though I’ve been retired for years. I’m not going to let my license expire.”

While Sharon no longer works in a nursing capacity, she still spends a lot of time in health care facilities. But now, she volunteers to lift patients’ spirits with the help of her Golden Retriever, Dunlop.

“Dunlop is a certified therapy dog, and she loves her job,” Sharon elaborates. “And she’s fantastic at her therapy work. She always brings a smile to everyone’s face. Now, I’m back in the hospital with my favorite companion. The volunteer work is very rewarding for me, for both of us.”

While Sharon is thrilled with her new vocation, she didn’t always look the part. Some people thought she was sad because her eyes were constantly tearing. But she wasn’t sad at all. While it may seem contradictory, excessive tearing is actually a common symptom of dry eye disease.

“I’ve had dry eyes for a very long time,” Sharon says. “I couldn’t wear contact lenses because they would stick to my dry eyes. The condition must be hereditary because my father had horrible dry eyes.

“The dry eye got to the point that my eyes were constantly watering, from morning till night. I didn’t have any pain or other symptoms, just the tears pouring down my cheeks all day. People would stop me and ask, Are you okay? because I always looked like I was crying. That went on for years.

“I went to an eye doctor, and we tried everything under the sun to help my dry eyes – everything from plugs to RESTASIS® and Xiidra®, but nothing worked. After that, my doctor said there was nothing else we could do. I was at my wit’s end. Fortunately, someone recommended Dr. Salinger, and I went to see him at once.”

When Sharon met with Dr. Salinger, he explained that the oil glands in her eyelids had become clogged with debris. They weren’t releasing enough of the oils necessary to keep a good, consistent tear film on her eyes’ surfaces, which keeps the eyes moist. The lack of a consistent tear film was causing Sharon’s eyes to be dry and irritated, which made them tear up.

Thermal Pulsation

Initially, Dr. Salinger treated Sharon’s dry eye disease with a regimen that included preservative-free, over-the-counter, sterile artificial tears; hot compresses, lid cleansings, vitamin supplements specifically for dry eye, and anti-inflammatory eye drops to reduce the inflammation that contributes to the evaporation of tears.

“That treatment protocol improved Sharon’s symptoms somewhat, but only incrementally,” Dr. Salinger reports. “We finally recommended treatment with the LipiFlow® and went ahead and performed it in January 2019.”

The LipiFlow Thermal Pulsation System from TearScience® combines the controlled application of therapeutic heat with a gentle, pulsating massage. These two functions work to liquefy then remove clogging debris from the glands in the eyelids, 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 eyelid’s 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.

“LipiFlow can be performed in different ways. Many doctors perform LipiFlow only. We perform a three-step process that includes treatment with the LipiFlow. Step one in the process is a very thorough deep cleaning of the eyelids. Step two is treatment with the LipiFlow itself.”

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.

“We believe that by doing step one and step three in combination with the LipiFlow treatment, individuals get more benefit sooner than if we didn’t do all three steps,” Dr. Salinger observes. “The benefits also last significantly longer when the three-step process is used.” The results are astounding.

Dr. Salinger reports that 90 percent of people experience measurable improvement after one LipiFlow treatment at The Dry Eye Spa & V.I.P. Laser Eye Center. About half of those patients notice improvement within one month. For the other half, it may take two to three months. For a very small percentage, it may take longer.

Miracle Cures

Sharon noticed a significant difference in her dry eye symptoms shortly after completing her three-step LipiFlow process. She continues to follow Dr. Salinger’s instructions for aftercare to maintain the results she achieved from the process.

“Within two months of getting the LipiFlow, my tearing stopped,” Sharon enthuses. “It’s such a relief to not have tears pouring down my cheeks all day.

“Every morning – and I’m religious about it – I put warm compresses on my eyes to keep the oils in my glands flowing freely. I take fish oil and use over-the-counter eye drops three or four times a day, then I’m good to go. I’m perfectly fine now. My eyes aren’t tearing anymore. The difference is like night and day.”

Like Sharon, Charles noticed an improvement in his vision soon after having treatment – in his case, the LASEK surgery, which Dr. Salinger performed in August of this year.

“I noticed a difference right away because the distance vision in my left eye was very blurry,” Charles states. “After a few weeks, I could see well enough to read road signs. And that’s the main thing I needed. And my vision just keeps getting better every day.

“The corrections Dr. Salinger made for my distance vision affected my near vision. I do have to wear reading glasses, but I don’t mind that at all. I don’t have to wear regular glasses, and that’s what I wanted.”

“I absolutely recommend Dr. Salinger and The Dry Eye Spa and V.I.P. Laser Eye Center, and already have,” Sharon says. “Three or four of my friends have gone to him.

“Dr. Salinger’s treatment is amazing. My dad had horrible dry eyes, and he was basically told he had to live with it. But today, people don’t have to live with it. There are new things such as the LipiFlow that can help resolve it. It’s like a miracle.”

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