Tailored Treatments

Different eye problems require separate strategies.

Five years ago, Michael Peacock decided to retire and make Florida home for good. For years, he’d split his time between Florida and Nantucket, Massachusetts, where he was a car dealer for 40 years.Stock photo from istockphoto.com.
Over the years, Michael went to eye specialists in both states. Not one could help with the chronic eye condition that afflicted him, until last spring, when he found a doctor with the solution.
“I’ve had dry eye for a number of years,” elaborates the Washington, DC native. “My eyes were always dry, burning and stinging, and they hurt inside. When I woke up some mornings, there’d be so much gunk in my eyes that my eyelashes would be stuck together.
“I went to doctors in Palm Beach and Nantucket. I even went to an eye institute in Boston, and all they did was give me eye drops. I must have had a list of twenty over-the-counter drops and ten prescription drops, and none of them worked.”
Michael felt resigned to his fate until he picked up a copy of Florida Health Care News and read an article about Clifford L. Salinger, MD, the founder of The Dry Eye Spa & V.I.P. Laser Eye Center in Palm Beach Gardens.
The article told the story of how Dr. Salinger specializes in dry eye disease, which afflicts millions of Americans, causing many uncomfortable symptoms such as intermittent blurry vision, excess tear production, itching, burning and stinging. Dr. Salinger provides extensive education and testing, as well as comprehensive treatment for the disorder.
“Dry eye and other ocular surface diseases are progressive conditions attributed to numerous factors, including age, hormone changes such as menopause, diet and medications,” observes Dr. Salinger. “Another factor is the chronic insult to our bodies that we perpetuate every single day in our environment.

“I fought dry eye disease for years, and in three appointments with Dr. Salinger, it was gone.” – Michael

“We teach our patients how to avoid environmental situations that make symptoms worse, such as exposing their eyes to direct, blowing air. We also explain how incomplete blinks can dry out the eyes and how people have more incomplete blinks when driving, reading or watching TV. They have even more when using electronic media.”
After reading the article, Michael was confident that he could finally find help for his dry eye problems at The Dry Eye Spa & V.I.P. Laser Eye Center. He soon discovered his trust in Dr. Salinger’s skill set was not misplaced.
Before beginning any treatment, Dr. Salinger uses specific tests to assess his patients’ dry eye disease. These include the LipiView® test for evaluating the oil layer of the eyes; tear osmolarity, which measures the salt concentration in the eyes; and a test called InflammaDry® for assessing the presence of inflammation.
“Dry eye disease patients are often treated for aqueous deficiency, or not enough of the water layer,” notes Dr. Salinger. “What we now know is that the majority of the condition is typically caused not by aqueous deficiency but by evaporative tear deficiency, which is a problem caused primarily by the dysfunction of the oil glands.”

Trailblazing Treatment

After testing and getting a better idea of the extent of Michael’s condition, Dr. Salinger began treating Michael with a comprehensive therapy for dry eye disease. This includes hot compresses, education on lid hygiene, vitamin supplements, anti-inflammatory drops (if necessary) and additional prescription eye medications.
“Typically, I put people on this treatment protocol for about a month, then bring them back in and evaluate their progress,” reports Dr. Salinger. “If the treatment has been successful, great. If not, I introduce the concept of the LipiFlow®.”
In treating cases of dry eye disease that don’t respond to the standard comprehensive therapy, Dr. Salinger turns to the LipiFlow Thermal Pulsation System from TearScience®. The system relieves dry eye symptoms by removing blockages of the 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.
“Dr. Salinger initially tried a few different treatments, including hot pads and eye drops,” confirms Michael. “He was trying to open up my tear ducts and relieve the dry eye symptoms, but those treatments didn’t work. After about three tries, he said, You need the LipiFlow procedure.”
Dr. Salinger confirms that after a month of receiving treatment, Michael’s dry eye symptoms improved by about 50 percent. Michael’s condition improved further after Dr. Salinger added another eye medication to his treatment plan, but the improvement plateaued shortly thereafter, prompting the consideration of LipiFlow.
“He was still having significant periods of discomfort,” Dr. Salinger notes. “After that, he asked what else could be done, and I proposed the LipiFlow. He agreed, and it was performed on April 27, 2017.”Stock photo from istockphoto.com.
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 LipiFlow, which Dr. Salinger calls a “revolutionary breakthrough’’ for treating chronic dry eye disease, an eyepiece contacts the outer eyelid and contains a soft, flexible bladder that intermittently inflates to provide controlled pressure and massage. Heat is also applied to the inner surface of the lid because of its proximity to the glands. These functions liquefy then remove clogging debris from the glands.
“Other doctors don’t typically do the expression of oil glands, but we find that adding this step enhances the benefits of LipiFlow more rapidly, and they last longer,” says Dr. Salinger. “This step can double or triple the duration of the benefits, saving people time, energy, money
and distress.
“What we also find is that ninety percent of the individuals we treat in our office with LipiFlow experience some improvement to significant improvement of their dry eye disease after one treatment.”
Michael is among those who marveled at the results of the treatment.
“It was unbelievable all the gunk that came out of my ducts when Dr. Salinger did the LipiFlow treatment,” he shares. “None of those drops I’d been using for years could get down into my eyes to help because my ducts were all clogged up. But the LipiFlow really cleaned them out.”

Doctor Recommended

Retired business owner and snowbird Bruce Davis didn’t have dry eye disease like Michael. 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 him.
“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.”

Vision 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.
“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.”

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

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.”

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, however, 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 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.
To prepare the patient for iLASIK, Dr. Salinger uses a diagnostic technology called iDesign that creates an individualized eye map, much like taking a unique fingerprint. The technology incorporates the WaveScan WaveFront® System and captures the imperfections of the patient’s eye in ultra-high definition. It then designs a custom laser treatment for the patient.
“This is the best technology available, and if one of my daughters or another family member were to have laser vision correction, this is what I would want for them,” assures Dr. Salinger. “I would want to offer them the very best technology there is. So why wouldn’t I want that for my patients, too?
“iDesign further improves accuracy, precision and, ultimately, what people are after: the very best results they can get.”

Delightful Experiences

Michael and Bruce had different eye problems, but Dr. Salinger had effective treatment strategies for each of them. For Michael, it was the “revolutionary breakthrough” LipiFlow procedure. For Bruce, it was the safe and precise laser vision correction. Both men achieved excellent outcomes from their treatments.
“Once the LipiFlow cleared out my ducts, the eye drops started to work for my dry eye symptoms,” reports Michael. “Right after the procedure, Dr. Salinger gave me some eye medicines and some heat treatments to do.
“Every time I saw him after that, he took me off a medication. Now, I hardly do anything for my eyes anymore. I have no more prescription eye drops. All I have is one over-the-counter drop with no preservatives that I use if I begin to feel a little dry.”
Dry eye is a progressive disease, so Michael must continue to monitor and care for his eyes.
“I might feel a little itching and burning every once in a while when I first wake up, but then I just put in a drop or two of the over-the-counter eye drops to keep my eyes moist,” he notes. “I get very little gunk in my eyes anymore. I take hot showers in the morning, so if there is any gunk, I put my eyes into the shower spray, and that cleans it off.”
Like Michael, 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 Michael are grateful to Dr. Salinger and his staff for their successful outcomes. The men 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.”
“I fought dry eye disease for years, and in three appointments with Dr. Salinger, it was gone,” marvels Michael. “I’m one hundred percent happy. I give The Dry Eye Spa and V.I.P. Laser Eye Center an A-plus!”

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