On Your Marks

New technology leads to better results for LASIK patients needing cataract surgery.

A long-time sufferer of an autoimmune disease, Denis Goudreau has always had to pay a little more attention to his eyesight than most. The eyes, after all, are where many autoimmune sufferers often find problems brewing first.

Photo by Nerissa Johnson.

Leading-edge technology allowed Dr. Kotick (foreground) to solve Dennis’ complex case.

A pharmacist until he retired a couple years ago, Denis considered excellent vision a prerequisite to doing a good job. That’s why, nearly two decades ago, he chose to have LASIK surgery.
The LASIK, Denis reports, worked wonders, allowing him to see clearly again and read everything from a doctor’s scrawl on a prescription he held in his hand to the words on a street sign off in the distance while driving at night.
It wasn’t long ago, though, that Denis began to detect deterioration in his vision. He noticed that he was no longer seeing objects either up close or far away as crisply and clearly as he had before and that he was seeing halos around lights at night.
“When I had the LASIK surgery, I had one eye set for distance and the other set for close vision,” Denis explains. “But it got to a point where I had to wear a contact lens in one eye to be able to see far away again.
“And the halos were so bad that I absolutely began to avoid driving at night. There were some medical consequences as well. I’m a vascular headache type of person, and when my eyes are strained, it can provoke that type of headache. I found I was starting to get a lot of those as well.”
Denis’ discomfort prompted a visit to Alexandra Kostick, MD. A board-certified ophthalmologist at Atlantic Eye Center whose family Denis served for years as a pharmacist, Dr. Kostick has in turn been serving Denis for his eye care since 2014.
“When I first started seeing Denis as a patient, he was having a lot of problems with dry eyes and red eyes, which were probably related to his autoimmune disease,” Dr. Kostick relates. “At the time, though, I could see there were some cataracts developing as well, though they weren’t really bothering him then.”

A Complex Case

The symptoms Denis reported upon his return to Dr. Kostick suggested his cataracts had grown worse. An exam by
Dr. Kostick confirmed as much. It also revealed a serious retinal issue that would require the aid of a retinal surgeon, whom Denis was referred to by Dr. Kostick. Before the retinal surgeon could do his job, however, the cataracts had to come out.

Photo by Nerissa Johnson.

A retired pharmacist, Denis (left) is typical of the
patients Dr. Kostick sees at her family-oriented practice.

“It was quite a complex case,” reports Dr. Kostick.
The problem for cataract patients who have had some type of refractive surgery, such as LASIK, Dr. Kostick explains, is that their eyes can no longer be measured preoperatively the way an unaltered eye would be using standard instruments. If they are, the patient often winds up being either nearsighted or farsighted and in need of corrective lenses.
“We call that the post-op surprise,”
Dr. Kostick educates. “It’s something we began to discover several years back. Patients weren’t getting the clarity they were expecting because the implant was wrong.
“The reason the implant was wrong was because, once the cornea has been touched with some type of refractive surgery, the measurements are off. In the case of Denis, who had LASIK done twice, it would have been double the confusion.”
The potential for confusion and a result that was far less than desirable was so great in Denis’ case that Dr. Kostick admits she probably would have referred him to a larger cataract treatment center in Jacksonville or Orlando had she not recently invested in a machine called the ORA.
ORA stands for Optiwave Refractive Analysis. It is a diagnostic device that allows eye surgeons to obtain accurate measurements of the shape of the eye during procedures such as cataract surgery after the cataract has been removed. Without it, Dr. Kostick says, clearing up Denis’ vision would have been “a guessing game.”
“The ORA fine-tunes the power of, and therefore narrows down the selection of, the intraocular lens implant,” Dr. Kostick adds. “There’s just no way that our pre-op measurements can compete with it. It helps to make the patient’s end result much, much better, and a good end result with a patient having cataract surgery, of course, is a patient who sees extremely well.”
Denis reports that, thanks to the use of the ORA machine, he was seeing images both far away and up close more clearly within a day of undergoing cataract surgery. He adds that his vision continued to improve in the days following the surgery and that he is no longer apprehensive about driving at night.
“Denis has done so well postoperatively that the retinal surgeon canceled plans to do the retinal surgery because he no longer needs it,” informs Dr. Kostick. “The cataract surgery fixed all his problems.”

“She has done a great job of getting my vision back to the best it can possibly be.” – Dennis

Denis isn’t surprised. As a former pharmacist suffering from an autoimmune disease, he has always been very particular about choosing health care providers. He says he only chooses “the best and most highly qualified” physicians, and he certainly ranks Dr. Kostick in that category.
“I really like her approach,” Denis explains. “She’s very thorough and did a great job of explaining the procedure, what I had to do prior to it and what to expect afterward. And obviously, she has access to the best technology that allows for the best possible outcome. I am so very happy with my choice.”

Generation After Generation

As a former associate in the medical profession who served not only Dr. Kostick’s parents but Dr. Kostick herself, he is typical of the kind of patient Dr. Kostick has spent the past 22 years building her practice around.
“I have had patients whose children I have seen, and now I’m seeing their children’s children,” Dr. Kostick says. “In other words, we don’t just take care of one patient; we take care of entire families. We consider ourselves to be a family inside the office, and we extend that feeling to the patient.
“We give very individualized, specialized care, and we don’t rush our patients in and out. We’re not a factory or a conveyor belt, so to speak. Our patients are our number one priority, and many of them come to us through word of mouth, which I think is an indication of our status in the community and how well respected our practice is.”
Dr. Kostick has certainly earned Denis’ respect.
“She’s been my eye physician for some time now because I like that she’s very systematic and cautious in her approach, which I believe is appropriate,” Denis relates. “When I realized I had this issue, I knew I was in tremendous hands with Dr. Kostick. She has done a great job of getting my vision back to the best it can possibly be.”

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    • Atlantic Eye Center

      Flagler County’s leading female board-certified ophthalmologist, serving the county since 1996, is at Atlantic Eye Center. Benefits the center offers you include: A multi-trained and highly regarded doctor Unparalleled eye care experi... Read More

    • Alexandra Kostick, MD, FACS, FRCSC

      Alexandra Kostick, MD, FACS, FRCSC, is board certified by the American Board of Ophthalmology. After earning her medical degree at the University of Manitoba in Winnipeg, Dr. Kostick served a mixed surgery internship at St. Boniface Hospital at... Read More