Tailored Treatments

After years of compensating for her increasingly blurry eyesight, Diana* finally accepted the need for cataract surgery early in 2018. At the same time, the New Zealand native and former snowbird from Upstate New York was also experiencing other issues with her eyes that further compromised her vision.Stock photo from istockphoto.com.
“My eyes were really bothering me, and not just from the cataracts,” she reflects. “There was also terrible itchiness, redness, grittiness and a feeling there was something stuck in my eyes all the time. All of these symptoms were related to my dry eye disease.
“I was having a lot of difficulty with my vision. Some of that was because of the cataracts and some of it was due to the dry eye. They both contributed to my vision being blurry and not as good as it should be.”
According to Diana, dry eye disease is a nasty disorder to have. She tried treating hers with popular, over-the-counter eye drops but never received lasting relief from them. The symptoms always returned.
“People can’t treat dry eye with over-the-counter drops and live normally with it,” she shares. “It doesn’t work that way. The dryness, redness, burning and feeling of something in my eyes never went away with the over-the-counter medications. They were just a temporary fix.”
When Diana consulted with the ophthalmologist who was to perform her cataract surgery, he suggested she have her dry eye treated before surgery. Not treating the dry eye before cataract surgery may lead to less accurate measurements, less than ideal results and worsening of the dry eye condition.
Diana’s doctor told her about a new treatment for dry eye called LipiFlow®, then referred her to Clifford L. Salinger, MD, founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens.
Dr. Salinger specializes in dry eye disease, which afflicts millions of Americans. He provides extensive education and testing, as well as comprehensive treatment for the disorder. Among the treatments he provides is the LipiFlow Thermal Pulsation System from TearScience®.
“Dry eye disease, also called ocular surface disease, is caused by a combination of factors,” Dr. Salinger points out. “Among those are a reduction in the quantity of tears on the surface of the eyes and a decrease in the quality of the tears produced. Tear quality includes the composition and amount of oils in the eye’s tear layer.
“LipiFlow is a revolutionary breakthrough for treating chronic dry eye disease. 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.”
“I spoke to my ophthalmologist about LipiFlow, then did some research,” states Diana. “I also read an article about Dr. Salinger in Florida Health Care News and saw that he also expresses the oil glands in the eyelids. I wanted to do whatever would make my eyes better, so I called and made an appointment.
“I told Dr. Salinger I wanted to have the LipiFlow as soon as possible. I believed it was going to be a good solution for me.”

The Finish Line

“Diana came to us in mid March of this year with significant dry eye disease in both eyes,” notes Dr. Salinger. “Her cataract surgeon was savvy enough to understand that significant dry eye disease affects the cataract surgery in several critical ways.
“First, it makes the surgery more challenging. Second, healing after surgery is slower. Third and most important, dry eye alters the measurements and calculations necessary to determine the appropriate lens implant strength for the best uncorrected vision following surgery.
“The ophthalmologist rightly told Diana to treat her dry eye first to improve the condition of her eyes’ environment and stabilize the disease. Then her surgery, healing and choice of implant would be more straightforward.”
After doing several tests to determine the extent of Diana’s condition, Dr. Salinger began her on a comprehensive therapy for her dry eye disease. For Diana, this included hot compresses, lid hygiene with special cleaning agents, vitamin supplements, a mild steroid drop for inflammation, and antibiotic drops and ointment.
“After two weeks of treatment, Diana was still having quite a bit of discomfort because the surfaces of her eyes were so dry,” reports Dr. Salinger. “So, on April third, we did the LipiFlow treatment, and she did very well with it.”
The three-step LipiFlow treatment takes about an hour, with cleaning of the eyelids before the procedure and expressing the oil glands in the eyelids afterward.
“During the LipiFlow procedure, an eyepiece contacts the outer eyelid and contains a soft, flexible bladder that intermittently inflates to provide controlled pressure and massage,” explains Dr. Salinger. “Heat is also applied to the inner surface of the lid because of its proximity to the glands.”
Both of these functions work to liquefy then remove clogging debris from the oil glands.

“I have no symptoms whatsoever since LipiFlow treatment.”– Diana

“Other doctors don’t typically perform the expression of oil glands, but we find that adding this step enhances the benefits of LipiFlow more rapidly, and they last longer,” observes Dr. Salinger. “This step can double or triple the duration of the treatment’s benefits.”
Dr. Salinger saw Diana three weeks after her LipiFlow procedure for a follow-up appointment. When he examined her eyes, they showed a great deal of improvement already.
“Diana was experiencing less redness, burning, tearing and overall discomfort,” he offers. “She returned to the office at five weeks post-treatment and said she was thrilled with the comfort in both eyes.”
With this substantial improvement in Diana’s dry eye symptoms, Dr. Salinger was able to cut back on some of the other treatments in her comprehensive therapy plan.
“We’re finding that eighty to ninety percent of our patients are getting significant improvement of their dry eye disease, although many don’t reach it as quickly as Diana,” Dr. Salinger asserts. “She was more motivated than the average person because she saw the finish line as the chance to have vision-correcting cataract surgery.”

Doctor Recommended

Retired business owner and snowbird Bruce Davis didn’t have dry eye disease like Diana. He struggled with another condition – distorted vision in both eyes. It was an issue that started in his youth.

Photo by Jordan Pysz.

German measles at six led to Bruce’s vision problems as an adult

“I had German measles when I was six, and the high fever caused changes in my corneas that left me with pretty bad eyesight,” explains the York, Pennsylvania native. “It made me terribly nearsighted, so I’ve worn glasses or contact lenses since I was a kid, and with either the glasses or contacts, I actually had pretty good vision.”
He did until recently, when Bruce, 69, noticed he was having issues while wearing his contacts, which he preferred over glasses. The issue was one that annoyed him more than hurt him.
“If I wore my contacts for eight to ten hours, they would become uncomfortable,” he describes. “They didn’t feel dry necessarily, although eye drops helped. They were just uncomfortable, and I’d have to take them out. I asked some opticians about possible treatments, and they suggested I see Dr. Salinger.”
Bruce took the opticians’ advice and made an appointment at V.I.P. Laser Eye Center. He was amazed by the thoroughness and precision of Dr. Salinger’s approach to testing and treatment.
“I thought Dr. Salinger was a wonderful doctor,” comments Bruce. “He’s very detail-oriented and careful about getting things right. We had a lot of problems getting the prescription correct on my left eye, but he never gave up on it. He just kept testing and testing until he got a result that satisfied us.
“After the testing, Dr. Salinger said that LASIK® surgery would work for me. But given my age and the fact that I’m in the first stages of cataracts, he left the decision up to me. I decided to have it done.”

Correction and Cataracts

“Bruce came to us asking, Am I too old for laser vision correction?” relates Dr. Salinger. “The answer used to be purely based on age, but not anymore. Age is a factor, but it’s not an absolute. The presence of cataracts is also a factor.”
Dr. Salinger explains that if a person has cataracts that are already significantly developed, then doing laser vision correction is not appropriate because surgery reshapes the cornea. As cataracts develop, they can affect the vision as well, making people slightly more myopic, or nearsighted.

“I no longer have to wear glasses or contacts!” – Bruce

“If we reshape the cornea with a laser while the lens is changing, we’re running in circles, like a dog chasing its tail,” offers the doctor. “We’re chasing the change in the lens as it becomes a full-fledged cataract. That’s not good practice.
“People who have little change associated with cataracts, as Bruce did, can still be measured for laser vision correction. However, in the presence of even early lens changes, we can’t predict how quickly the cataracts will develop and interfere with the surgery’s results. We anticipated that Bruce had a good amount of time because his lens changes were so minimal. He wanted to move forward with LASIK.”

Safety and Precision

LASIK corrects vision through a laser that changes the curvature of the cornea. A small flap in the cornea is created first, which is made by the eye surgeon, who cuts corneal tissue with a surgical blade.
The V.I.P. Laser Eye Center offers iLASIK – an all-laser vision correction that eliminates the need for the eye surgeon to use a surgical blade in preparing the cornea. With iLASIK, the flap is created by an ultra-fast laser. It offers even more precision and safety in achieving freedom from glasses.
“LASIK is already one of the safest and most accurate surgical procedures currently available,” informs Dr. Salinger. “The iLASIK technology improves safety even more and also contributes to significantly better results.
“Bladeless LASIK offers multiple benefits, but the biggest are a more uniform separation of the layers of the cornea, a more uniform flap thickness and a smoother surface after the flap is created,” he adds.
A goal of laser vision correction is to make people less dependent on corrective lenses. One way to do that is with monovision, which corrects one eye for distance vision and one eye for near vision.
“We proposed monovision to Bruce, but he didn’t like that idea,” remembers Dr. Salinger. “He wanted both eyes corrected for distance vision. He believed he would feel off balance with monovision. I warned him that, in all probability, his near vision would be compromised after surgery, but he wasn’t deterred.
“We did the LASIK procedure on February 22, 2018, and six days after the procedure, he was 20/20 in his right eye and 20/20 plus in his left eye. With both eyes open, he was reading most of the 20/15 lines on the chart, and against all odds, he was reading the absolute smallest print on the reading card, which is equivalent
to contract-size print.”

Wonderful Feeling

Immediately after getting the LipiFlow treatment, Diana’s eyes started feeling better little by little. Then, all of a sudden, she realized a burst of relief. She was amazed by the experience and by the treatment’s ultimate results.
“My eyes feel wonderful,” she marvels. “Dr. Salinger always asks me how I’m doing on a scale of one to ten, with ten being the best. When I last saw him, I said,
Dr. Salinger, you get a ten plus! The difference in my eyes is remarkable.
The comprehensive therapy plan created by Dr. Salinger, which included the LipiFlow procedure, eased the uncomfortable dry eye symptoms Diana suffered. She notes how extensive they were prior to treatment and how much better
they are now.
“The redness I had wasn’t just in the eyes,” she describes. “It was all along the edges, too, but it’s all gone now. The itching, grittiness and feeling of something in my eyes are all gone. I have no symptoms whatsoever since LipiFlow treatment. It’s wonderful.
“I know my vision will improve more after cataract surgery, but I got some improvement since the LipiFlow. Now, my eyes don’t get as tired as they used to when I’m reading or watching television. My vision is better in that respect.”
Like Diana, Bruce has become more independent as a result of Dr. Salinger’s work. He says his vision is better than ever and that he has become virtually glasses free.
“I no longer have to wear glasses or contacts!” Bruce exclaims. “I do wear glasses for reading, but I don’t mind that because my distance vision is excellent. I’m delighted with it now.”
Both Bruce and Diana are grateful to Dr. Salinger and his staff for their successful outcomes. They are also more than pleased with their experiences at The Dry Eye Spa & V.I.P. Laser Eye Center.
“I recommend the LASIK procedure and V.I.P. Laser Eye Center,” enthuses Bruce. “The staff is wonderful. They explain every step they’re doing and the results they’re getting. I’m delighted with the entire process. Dr. Salinger and his staff are just top-shelf, and I’m really pleased with my results.”
As Diana prepares for her cataract surgery, she knows it will go more smoothly now that she’s had her dry eye treated. She’s pleased with the difference the treatment has made in her daily life already.
“With the dry eye, my eyes were uncomfortable all the time; it was a twenty-four-hour thing,” she relates. “Now that I’ve had the LipiFlow with Dr. Salinger at The Dry Eye Spa and V.I.P. Laser Eye Center, it’s a really, really good feeling.”

*Patient’s name was changed to protect her privacy.
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