Shared Vision

Eye institute expands specialty services in Riverview.

The eye may be a small organ in the body, but it plays a big role in sensory perception. People receive more than 75 percent of their information about the world around them through the sense of sight.

Dr. Charles Luxenberg, Dr. Robert Applebaum, Dr. Marguerite Kohlhepp and Dr. Ronni Chen discuss the ophthalmic specialty services they provide at Florida Eye Specialists & Cataract Institute at Riverview.

Dr. Chen

The highly trained ophthalmologists at Florida Eye Specialists & Cataract Institute are committed to protecting eyesight and the health of their patients’ eyes. In April 2018, the Institute shared that vision and opened a satellite clinic in Riverview.

“Our vision is to be a full-service center in Riverview, taking care of a complete range of eye disorders,” emphasizes Robert J. Applebaum, MD, a board-certified ophthalmologist at the Riverview and Brandon locations. “We perform routine eye exams and prescribe eyeglasses, but we also treat more serious conditions such as diabetes-related eye diseases, macular degeneration and glaucoma, as well as perform cosmetic surgery.”

“It’s exciting for Florida Eye Specialists and Cataract Institute to have a location in Riverview,” offers Ronni M. Chen, MD, a board-certified ophthalmologist who is fellowship trained in pediatric ophthalmology. “I’m excited to provide specialty pediatric eye care in Riverview. I think it’s a great service to children and families in the area.”

Physicians in multiple specialties, including oculoplastic surgeons and retina specialists, rotate through the Riverview clinic, so area residents don’t need to travel for specialty eye care. And the physicians have access to advanced technology for testing and treatment.

“The Riverview clinic is state-of-the-art,” Dr. Applebaum asserts. “The office has the most updated equipment available, including a device that produces three-dimensional pictures of the retina as well as a high-tech peripheral visual field machine. We’ve also got two lasers that we use to treat various eye conditions.

“We have a very friendly staff, including a great office manager and front desk person. All of the techs who rotate through the clinic are highly motivated, really care about the patients and do an excellent job. I believe Florida Eye Specialists and Cataract Institute at Riverview is an excellent place to come for eye care.”

Laser Relations

As part of a routine eye exam, Charles A. Luxenberg, MD, a board-certified ophthalmologist, measures his patients’ vision and prescribes eyeglasses. The ophthalmologist also evaluates the overall health of his patients’ eyes and checks for any eye disorders.

“We treat many conditions in Riverview, including eye infections, inflammatory disorders, cataracts and glaucoma,” Dr. Luxenberg acknowledges. “If we discover cataracts, we refer the patients to our Brandon location for surgery, but we follow-up with them in Riverview for their postoperative care.

“Sometimes, a patient’s lens capsule will become cloudy following cataract surgery. If that occurs, we can perform a simple laser procedure to clear it up and return the patient’s vision to its post-surgery clarity.”

Dr. Luxenberg also uses a laser to treat the two main types of glaucoma, open-angle glaucoma and narrow-angle glaucoma. For open-angle glaucoma, the laser works directly on the outflow filter, or trabecular meshwork, of the eye. Opening up this meshwork with the laser enables the fluid in the eye to flow better, which lowers eye pressure.

“With open-angle glaucoma, something is wrong with the trabecular meshwork and its function is impaired,” Dr. Luxenberg explains. “As a result, there’s a back-up of fluid, which causes increased pressure in the eye. High eye pressure can damage optic nerve fibers, and that can lead to visual field defects and eventually blindness.

“With narrow-angle glaucoma, the angle of the outflow tract is narrow due to the anatomy of the person’s eye. This narrow angle causes the problem with fluid flow rather than the outflow filter itself being impaired. We use the laser to widen the angle.”

Treating patients with lasers is an important part of Dr. Luxenberg’s work at Florida Eye Specialists & Cataract Institute at Riverview. Another key function he performs is treatment for the terrible twosome of eye disorders: blepharitis and dry eye syndrome.

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

Dry eye syndrome, which is generally the result of clogged glands, is a condition where there aren’t enough tears on the surface of the eye to keep it adequately lubricated, thus the eyes become dry.

Blepharitis and dry eye commonly occur simultaneously. If left untreated, these conditions can lead to permanent eyelid and tear gland dysfunction as well as corneal damage.

“We treat dry eye with various eye drops, including the prescription drops RESTASIS® and Xiidra®,” Dr. Luxenberg observes. “We also use a laser procedure to close the tiny openings in the eyelid that drain fluid, called punctum. This procedure, laser punctal ablation, keeps the tears on the surface of the eye longer.

“For blepharitis, we recommend eyelid scrubs twice a day and also suggest a very effective therapy using a machine called BlephEx®. During a BlephEx treatment, we use the instrument to clear all of the debris from the eyelid margin and the lashes. It also thoroughly cleans those areas to kill any bacteria growing there.”

Functional and Cosmetic

Dr. Applebaum is the son of a cardiologist, so he had no shortage of inspiration to become a physician himself. But he wanted to be highly specialized, so he opted to pursue ophthalmology and focus his skills further by completing a fellowship in oculoplastic surgery. Oculoplastic surgery is a subspecialty that concentrates on cosmetic and reconstructive surgery of the face and eye area.

Dr. Applebaum uses his skills in ophthalmology and oculoplastic surgery to perform a wide range of cosmetic and functional procedures on the face and eyes, including blepharoplasty, at Florida Eye Specialists & Cataract Institute at Riverview.

“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 Riverview 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. These options can help reverse the changes associated with aging.

“BOTOX Cosmetic is a synthetic toxin that is altered so that it is non-toxic to the body of a healthy person,” Dr. Applebaum notes. “It blocks the release of neurotransmitters that trigger muscle contractions.”

Among the fillers used by Dr. Applebaum are JUVÈDERM®, VOLUMA® and RESTYLANE®. Many fillers contain hyaluronic acid, a substance found naturally in the body that helps restore volume and hydration to the skin.

“Over time, materials in the skin, including the collagen and base membranes, break down, so the face begins to sag,” the doctor explains. “We use these fillers in the cheeks to add volume and give the face a nonsurgical lift.

“We also use fillers in areas slightly lower on the face to decrease the appearance of fine lines and wrinkles around the nose and lips. Oftentimes, we use them in the lips to give the lips more fullness.

“KYBELLA® is another filler that is used specifically to decrease the appearance of a double chin. It is injected into the fatty tissue of the chin, where it breaks down the fat cells, reducing the appearance of fat under the chin.”

Retinal Restraints

The retina is a thin layer of specialized tissue that lines the back of the eye. It senses light as it enters the eye and sends it to the brain to process as images. Unfortunately, there are many disorders that affect the retina.

The two most common disorders of the retina are diabetic retinopathy and macular degeneration, which are the two leading causes of blindness in adults. Board-certified ophthalmologist and fellowship-trained retina surgeon Marguerite Kohlhepp, MD, has expertise in treating retinal diseases. She offers that expertise at Florida Eye Specialists & Cataract Institute at Riverview.

“Diabetic retinopathy is the most common eye disease associated with diabetes and is caused by changes in the blood vessels of the retina,” Dr. Kohlhepp states. “In some cases, abnormal blood vessels develop on the surface of the retina. In others, blood vessels begin to bleed or leak fluid.

“Anyone who has diabetes is at risk for developing diabetic retinopathy, and the risk increases with the duration of having the disease. The main reason: High glucose levels affect the blood vessels and make them unhealthy.

“Diabetic retinopathy generally has no symptoms in its early stages, so screening and early diagnosis are of incredible importance. We have treatments that will overturn poor visual outcomes, but they require early detection.”

Another serious threat to sight that can occur as people age is macular degeneration. It is a disease of the central vision with which the main images in the vision become less discernible.

“Think of the retina as being ten layers thick with many blood vessels nourishing it,” Dr. Kohlhepp elaborates. “Macular degeneration is a disease in which some of those layers essentially become diseased and waste away. As a consequence, some of the blood vessels pop and leak.

“The first situation, where the layers waste away, is what we consider dry macular degeneration. When blood vessels start popping and leaking, that’s what’s called wet macular degeneration. This type does considerable damage that translates into poor vision.”

The most common treatment for wet macular degeneration is anti-VEGF therapy. That involves injections of a medicine called anti-vascular endothelial growth factor, which inhibits new blood vessel growth.

Dr. Kohlhepp treats both medical and surgical retinal disorders. Diabetic retinopathy and macular degeneration are two examples of medical retinal disorders.

Dr. Charles Luxenberg, Dr. Robert Applebaum, Dr. Marguerite Kohlhepp and Dr. Ronni Chen discuss the ophthalmic specialty services they provide at Florida Eye Specialists & Cataract Institute at Riverview.

Marguerite Kohlhepp, MD

“Of the surgical disorders, some of the more common are retinal tears and retinal detachments,” Dr. Kohlhepp reports. “Then there are other disorders called macular pucker and macular hole.

“Macular pucker and macular hole are not as catastrophic as retinal detachment or vitreous hemorrhage, where there’s complete loss of vision that evolves very quickly, sometimes within hours or days. Macular pucker and macular hole are conditions that come on somewhat slowly and involve a disruption in the normal architecture of the macula.”

Dr. Kohlhepp suspects a retinal tear when patients report flashing lights or floaters, which are common complaints. Flashing lights and floaters can be due to normal changes of the eye, but one of five who present with those symptoms will likely have a retinal tear to explain them.

“A retinal tear is an unwanted consequence of a normal, age-related process where the vitreous gel between the lens and retina is liquefied, but that process is complicated by the vitreous inadvertently pulling at the retina,” she describes. “That’s how a retinal tear is formed.”

If a retinal tear occurs, it’s critical that it’s treated right away. If not treated immediately with laser or freezing, a tear lends itself to developing into a retinal detachment.

“The big, gaping hole in the retina allows fluid to pass through it,” Dr. Kohlhepp informs. “This fluid is found on the undersurface of the proverbial wallpaper, and the next thing you know, the wallpaper is falling off of the wall, and that’s a retinal detachment.”

Child Friendly

As a pediatric ophthalmologist, Dr. Chen treats all of the eye conditions that are commonplace during childhood and adolescence. Often, her patients are children who have failed screening exams by their physicians or schools.

Three eye disorders that Dr. Chen treats that can be corrected easily with eyeglasses are myopia, hyperopia and astigmatism. These are all refractive errors – vision problems caused by the eye’s inability to properly focus light on the retina to form clear images.

“Myopia is also known as nearsightedness, and hyperopia as farsightedness,” Dr. Chen educates. “Astigmatism is an irregularity that forms in the corneal tissue, causing part of the cornea to be steeper along one axis than another.

“I also treat other routine eye conditions, including blocked tear ducts, which can lead to infections, chronic tearing and foreign bodies children may get in their eyes while playing outside. Two of the most common eye disorders I see at the Riverview clinic are amblyopia and strabismus.”

Amblyopia, also called lazy eye, results when the eyes’ acuity develops unevenly. The brain accepts the visual images from the stronger eye and ignores the images from the weaker eye. Affecting four in every 100 children, amblyopia can be treated with eye drops or by placing a patch over the stronger eye, forcing the weaker eye to work harder.

Strabismus, or crossed eye, occurs as frequently as amblyopia and results from a misalignment of the eye muscles, which interferes with the ability of the eyes to work together. One eye may appear to drift, seemingly looking up, down, in toward the nose or out toward the cheekbone.

“Children coping with strabismus may squint one eye in bright sunlight or complain of eyestrain or headaches when trying to read,” Dr. Chen notes. “If the affected eye goes untreated, the child may develop amblyopia as a result of strabismus.

“Strabismus can occasionally be treated with eyeglasses that force the affected eye to work in concert with its partner. But the condition most often requires eye muscle surgery to align the eyes properly. Although this surgery is safe and effective, some children require more than one surgical procedure to fully correct the condition.”

On the days Dr. Chen provides her services at Florida Eye Specialists & Cataract Institute at Riverview, the office transforms into a child-friendly sanctuary. The environment and the personnel are all dedicated to the special needs of children. The staff use pictures, toys, even puppets to connect with the children.

“We have children’s movies playing, and we have a playroom for them,” Dr. Chen describes. “I’m a fellowship-trained pediatric ophthalmologist who’s been in practice for twenty-one years, and my staff is specially trained to treat children and make their eye exams as easy as possible for them.

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