Seeing Visions

Institute opens full-service eye clinic in South Tampa.

In September, Florida Eye Specialists & Cataract Institute opened a new eye clinic in South Tampa, where it offers a complete range of eye treatments and surgeries. The South Tampa practice is Florida Eye Specialists & Cataract Institute’s fifth location, further reinforcing the Institute’s commitment to serve the greater Tampa Bay community.

Photo by Jordan Pysz

From left to right: Scott Kohlhepp; Zohrab Kotchounian;
Dr. Pauline Thai; Stephanie Defreitas; Shelby Robertson; Brittany Smith

The new clinic is located at 3115 West Swann Avenue in Tampa, and it is an integral member of Florida Eye Specialists & Cataract Institute’s family of eye care centers that also includes clinics in Brandon, Riverview, Ruskin and Sun City Center. These full-service centers make quality eye care available to more patients in the region.

The physicians on staff at the South Tampa center provide general ophthalmology as well as specialty services. Those providing care at the practice include ophthalmologists Robert J. Applebaum, MD, who is also an oculofacial plastic and reconstructive surgeon; Deen G. King, MD, a glaucoma and cataract specialist; Dilip Rathinasamy, MD, a cataract specialist; Priya M. Mathews, MD, a cornea specialist; and Selina J. Lin, MD, a vitreoretinal surgeon, as well as optometrist Pauline Thai, OD.

At the South Tampa clinic, Dr. Applebaum uses his skills in ophthalmology and oculoplastic surgery to perform a wide variety of cosmetic and functional procedures on the face and eyes, including blepharoplasty.

“Blepharoplasty is a surgical procedure that involves removing excess eyelid tissue, which can make people look tired, sad or even mean upon first impression,” Dr. Applebaum describes. “Blepharoplasty can be done on both the upper and lower eyelids, and can make a dramatic difference in the appearance of the face.

“With upper blepharoplasty, excess skin is removed from the upper eyelids, which can droop due to muscle weakness. The repairs I perform help functionally because the excess tissue can get in the way of vision and endanger the patient. It can also cause headaches and other problems.

“I also perform blepharoplasties for cosmetic purposes, when people are unhappy with the appearance of their lids. These surgeries can significantly improve the look of their eyes.”

The lower lids can project a poor first impression as well.

“Most people are born with five bags of fat around the eye to protect it and hold it in the socket,” Dr. Applebaum educates. “However, with aging, that fat can come forward and appear as puffiness under the eye. Lower blepharoplasty can diminish the look of tiredness and aging by decreasing excess fat and skin beneath the eyes.”

Dr. Applebaum performs many other surgical procedures at the South Tampa clinic as well. These include reconstructions following skin cancer removal, endoscopic eyebrow and forehead lifts, tear duct surgery, earlobe reconstructions and correction of eyelid malposition.

In addition to these surgical procedures, Dr. Applebaum also offers a variety of nonsurgical facial cosmetic services. These include BOTOX® Cosmetic injections and a variety of facial fillers, including JUVÉDERM®, VOLUMA® and Restylane®. These options can help reverse the changes associated with aging.

Surgery Advancement

Surgery is an art form, and surgeons spend years perfecting their technique. Surgeons, like artists, are always striving to improve upon their craft. For the surgeons at Florida Eye Specialists & Cataract Institute, advancing with new technology is one way they refine their creative skills.

An example of this advancement is the LENSAR® Laser System for use during cataract surgeries, which are performed at the Brandon location. LENSAR is on the leading edge in femtosecond laser technology. Its added functions and precise laser incisions enable surgeons to remove the cataracts with increased safety and position the replacement lens, known as an intraocular implant, with greater accuracy. These innovations lead to better vision following surgery.

“The LENSAR automates certain aspects of the surgical process that were traditionally done by hand, and makes them more efficient, more effective and safer,” notes Dr. Rathinasamy, whom patients refer to as Dr. “Samy.”

“For example, the laser makes the initial incision into the eye. It can also create the capsulotomy, which is an opening into the thin, fragile membrane that holds the cataract, and it does so with exceptional precision.

“A capsulotomy done by hand can be less than perfect. It is important to have a perfect capsulotomy so the replacement lens can sit in a more optimal position, which ultimately gives the patient better vision.”

Though it also benefits the surgeon, the LENSAR Laser System allows patients to walk away from the surgery with the clearest vision possible. One way it does that is by affording the surgeon the technology to correct astigmatism during surgery.

Astigmatism is an imperfection in the shape of the cornea. With this defect, the cornea cannot help the lens focus light properly on the retina, which makes images blurry and distorted.

“To correct astigmatism, we make what are calleda which are tiny cuts in the cornea to reshape it,” Dr. Samy explains. “The corneal reshaping done by the LENSAR can reduce astigmatism and help people see more clearly after surgery.”

The LENSAR takes a scan of the cornea to confirm its dimensions before it applies the limbal relaxing incisions. This ensures more accurate incisions and astigmatism correction, and a better outcome for the patient.

“The LENSAR is a very nice adjuvant to advanced technology lenses such as Toric lenses,” Dr. Samy states. “It can mark the eye more accurately to align the Toric lens. The marking is done from a map that we create before surgery.

“The laser uses that and indicates the exact spot on the eye with a laser mark, and that’s where I place the lens. It allows us to more precisely align the replacement lens for better post-op vision.”

Photo by Jordan Pysz

From left to right: Scott Kohlhepp; Zohrab Kotchounian;
Dr. Pauline Thai; Stephanie Defreitas; Shelby Robertson; Brittany Smith

Vision Threat

As the second leading cause of blindness in the United States, glaucoma is a serious threat to vision. Glaucoma is the degeneration of optic nerve fibers that send signals to the brain, enabling vision to occur. It has been associated with abnormal eye pressure due to elevated intraocular fluid pressure. This increased pressure damages the optic nerve fibers, affecting vision.

Glaucoma has no obvious symptoms in its early stages, Dr. King warns, but as the disease progresses and more damage occurs to the optic nerve, blind spots may develop in the peripheral (side) vision. This often goes unnoticed until the disease is advanced and the damage to the optic nerve has become severe. Without treatment, this loss of vision can progress to blindness.

“It’s estimated that about four million people have glaucoma, half of whom don’t even know they have it,” Dr. King reports. “Unfortunately, there isn’t a cure yet, so early detection is critical. Once we catch glaucoma, we can control it. The earlier we catch it, the easier it is to control.
“When we catch glaucoma early, it is often the case that the patient will never have a problem with their vision. What we try to do is prevent them from ever developing a problem, so our treatments are geared toward reducing pressure within the eye. This reduction in pressure has been proven to slow down or halt the progression of glaucoma.”

Dr. King points out that for patients with mild glaucoma, the use of medicated eye drops or a laser treatment to lower intraocular pressure may be all that’s needed to keep the disease under control.

“In more advanced stages, some patients may require a procedure called surgical trabeculectomy to rechannel the drainage passages and improve the flow of excess eye fluids,” he says. This also lowers eye pressure.

Because glaucoma in its early stages has no symptoms, people with the disease often don’t seek medical attention until some vision loss has begun.

“We encourage screening for glaucoma as part of our routine eye exams, which every patient should have at least every year or two,” Dr. King observes. “Tests for glaucoma are performed for every patient and include measuring the eye pressure as well as analyzing the optic nerve.”

Terrible Twosome

Blepharitis and dry eye syndrome are a terrible twosome. These two conditions generally occur simultaneously, and if left untreated, they can lead to permanent eyelid and tear gland dysfunction as well as corneal damage.

Blepharitis is an infection of the eyelids and eyelashes. It is most commonly caused by an overgrowth of bacteria that live along the margins of the eyelids and at the base of the lashes.

“Symptoms of blepharitis include itching, burning, tearing, a foreign body sensation and a red line along the lid margin, almost as if the person is wearing red mascara,” Dr. Thai asserts.

In addition to those symptoms, blepharitis can also produce substances that inflame the meibomian glands. Meibomian glands supply meibum, an oily substance that prevents evaporation of the eye’s tear film, thus causing dry eyes.

Dry eye is a chronic lack of sufficient lubrication or moisture in the eye. It occurs because the glands are not producing enough tears. With dry eye, some people experience eye fatigue, redness, double vision and glare, and some actually have tearing. Inflammation is common to both conditions.

“Blepharitis and dry eye can be very debilitating, and blepharitis can actually lead to dry eye because it damages the glands that make tears,” Dr. Thai states.

“The two conditions are interrelated. When people’s lid hygiene is compromised, it causes a build-up of bacteria on their eyelashes. The resulting infection causes dry eye by plugging the oil glands in the lids.”

The eye complications associated with blepharitis and dry eye can be treated and possibly prevented if eyelid hygiene is properly undertaken. Approaches to cleaning the eyelids have improved over the years. Just two years ago, in fact, an eye physician invented a mechanized system for scrubbing and massaging eyelids infected with blepharitis bacteria called BlephEx®.

“During a BlephEx treatment, a medical-grade micro sponge is dipped in a solution similar to that in eye scrub pads,” Dr. Thai explains. “The sponge is placed on a small tool that resembles a drill, but instead of a drill bit, there’s a soft sponge. The tool gently spins to scrub and massage the eyelid margins, cleaning and exfoliating the eyelids and lashes and relieving symptoms.”

Selective Transplant

Dr. Mathews joined the medical staff at Florida Eye Specialists & Cataract Institute in September. She performs the full range of corrective eye procedures, including cornea surgery, refractive surgery (including LASIK®) and cataract surgery. Her primary interest is the treatment of conditions affecting the cornea.

“There are certain surgeries I learned over the past few years that, prior to my arrival, weren’t widely available in the Tampa Bay area,” Dr. Mathews notes. “One of those techniques is DMEK, which is an acronym for Descemet membrane endothelial keratoplasty. DMEK is a newer, more advanced type of cornea transplant.”

The cornea is made up of five layers, and during a traditional cornea transplant, the entire cornea is removed and replaced with donor tissue. With the newer surgical techniques, including DMEK, surgeons can select the diseased layer of the cornea and replace only that layer.

During DMEK, the surgeon removes and replaces a very thin layer of the cornea. In this case, it’s two layers, the Descemet membrane, the basement membrane that lies deep in the cornea, and the endothelium.

“Techniques such as DMEK, which transplant only a portion of the cornea, provide patients with much better vision than can be achieved by replacing the entire cornea,” Dr. Mathews asserts. “And because the patient is keeping most of their own cornea and only receiving a small piece of donor tissue, there’s less chance for rejection.”

Dr. Mathews also performs keratoprosthesis surgery, which is the replacement of the entire cornea with an artificial cornea. This may be an option for patients who are not suitable candidates for fresh tissue transplant.

“Cornea transplants are the most frequently performed transplants in the world, so advances such as DMEK and artificial corneas are really exciting,” she relates.

Laser Assistance

Another surgery commonly performed by the specialists at Florida Eye Specialists & Cataract Institute is LASIK laser vision correction. LASIK, an acronym for laser-assisted in situ keratomileusis, is the most commonly performed laser eye surgery to treat vision problems such as myopia (nearsightedness), hyperopia (farsightedness) and astigmatism.

“The bending and focusing of light onto the retina is called refraction,” Dr. Mathews describes. “If the shape of the cornea is not perfect, the light on the retina is distorted, causing refractive errors such as nearsightedness and farsightedness.

“During refractive surgery, the surgeon reshapes the cornea using specialized lasers. Reshaping the cornea enables light entering the eye to be properly focused onto the retina, correcting the refractive errors. With the errors corrected, clearer vision results.”

LASIK surgery involves first creating a superficial, hinged flap on the surface of the cornea using a femtosecond laser. Once that is done, the surgeon folds back the flap to access the underlying corneal tissue, the stroma. The surgeon then removes some of the corneal tissue to reshape it using a second, programmed laser called an excimer laser.

“After the surgeon reshapes the cornea with the excimer laser, they place the flap back into place to cover the area where tissue was removed,” Dr. Mathews describes. “Eventually, the flap heals and seals onto the underlying cornea.”

LASIK surgery is relatively painless and performed using anesthetic eye drops. Surgeons may also give patients a medication to help them relax during the procedure. Surgery is generally completed in less than 20 minutes. If both eyes need correction, doctors will typically operate on both eyes the same day.

Follow the Leaders

Dr. Lin’s decision to become a retina surgeon bore her father’s influence. When she first showed interest in eye care, her father, an anesthesiologist, encouraged her to learn everything she could about the specialty.

“My father’s good friend was one of the first doctors in Florida to perform LASIK eye surgery,” she remembers. “When I was young, I went to his office and watched him perform LASIK, cataract and other eye surgeries. The experience got me really interested in ophthalmology.

“During my residency, my father was working at University of Florida Shands Hospital, and became good friends with the department of ophthalmology chairman, who was a vitreoretinal surgeon. After talking with him, I became interested in retina care.

“Whenever I came home during my residency, I went into the operating room and watched this vitreoretinal surgeon perform surgery. That’s how I was exposed to retina surgery, and I remember thinking, This is for me.”

After completing her fellowship, Dr. Lin spent a brief time in Cleveland, Ohio. But after a few years, she returned to Florida and practiced vitreoretinal surgery in the greater Tampa area for ten years.

Like Dr. Mathews, Dr. Lin recently joined the staff at Florida Eye Specialists & Cataract Institute. Dr. Lin offers medical treatment for retina diseases as well as retina surgery at the new South Tampa location.

“It’s very exciting that Florida Eye Specialists and Cataract Institute is making its presence felt in the South Tampa area,” Dr. Lin relates. “It’s a pioneering move for them to extend into South Tampa, and they have a plan for growing that practice. I’m pleased and proud to be a part of that plan.”

photos by Jordan Pysz

The new South Tampa office of Florida Eye Specialists & Cataract Institute

 

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