Author Archive

It’s Cataract Awareness Month

Here’s everything you need to know about cataract surgery.

Cataracts are a clouding of the normally clear lens of the eye. Cataract surgery, which involves the replacement of the cloudy lens, is one of the most common procedures in the country, with more than 3.5 million performed annually.

Thanks to medical advances, cataract surgery is safer and now provides better outcomes than ever. With this sophisticated technology, procedures can be customized to find the best fit for patients. But, it can be challenging to choose between the myriad of new options available.

It’s Cataract Awareness Month, which makes now the perfect time to review the signs of cataracts, the latest technology available for treatment and what to expect with surgery.

Signs You Need Surgery

“By age 80, more than half of Americans have been diagnosed with a cataract or have had cataract surgery,” says Rajesh K. Shetty, MD, ophthalmologist and CEO of Florida Eye Specialists. “However, many of my patients don’t realize that cataracts can begin to develop early in their 40s and 50s.”

Dr. Shetty says cataracts develop slowly and painlessly over time. In the early stages, symptoms may be so mild that patients don’t realize their vision is changing. But as a person ages, cataracts can grow to the point where they can get in the way of living an active, independent life.

“Cataracts can affect night vision, meaning you may not be able to drive home from work in the evening,” Dr. Shetty says. “As people continue to work later and later in life, this becomes a big problem for our patients.”

Those with advanced cataracts may also experience blurry vision, double vision, sensitivity to glare and light, and fading colors, and they may need to change their prescriptions for glasses or contacts more frequently.

Vision needs have become more demanding with advances in technology and today’s active adult lifestyle.

“Vision needs have changed a lot,” Dr. Shetty says. “We spend much more time looking at phones and other devices with our friends and family communicating with us constantly. We’re traveling more, looking at GPS, driving during dusk, dawn, rain and nighttime. We’re playing golf and reading. The demand for clear vision at all ages is the highest it’s ever been.”

Types of Surgery

If you are planning to have cataract surgery, there are two options to choose from: traditional and laser-assisted.

“Traditional cataract surgery is one of the most common and safest surgeries in the world,” Dr. Shetty says. He explains that one of the primary benefits to traditional cataract surgery is that most health insurance plans will cover at least part of the cost of the procedure.

However, Dr. Shetty says, traditional cataract surgery does have limitations. It cannot correct astigmatism, and patients who receive traditional cataract surgery will still need to wear glasses for intermediate and near vision.

Unlike traditional cataract surgery, where a scalpel is used to make an incision in the eye by hand, laser cataract surgery is guided by computer. The surface of the eye is mapped to tell the laser the exact location, size and depth for incisions. This results in a safer, gentler procedure.

The laser also creates a more precise and accurate outcome. Dr. Shetty says this allows eye surgeons to correct a range of vision problems – including astigmatism, farsightedness and nearsightedness – at the time of cataract surgery. This gives you the option to correct two conditions with one procedure, and reduces or possibly eliminates the need for glasses.

Dr. Shetty has had great experience with this procedure. Florida Eye Specialists was the first practice in Northeast Florida to offer laser cataract surgery to patients and has performed nearly 7,000 procedures to date.

Before and After Surgery

Prior to cataract surgery, Dr. Shetty says, your eye surgeon should walk you through the steps of the procedure to answer any questions that may come up. Some important questions to ask include what kind of cataract surgery is available to you and what kind of replacement, or intraocular lens (IOL), you can choose from.

“It can be hard for patients to remember the questions they should ask in the moment, so we recommend writing your questions out in advance and bringing them with you to the appointment,” Dr. Shetty says.

During the operation, you’ll be given a local anesthetic to numb the area around your eye. The sedation will make you feel a bit groggy afterward, so you’ll need someone to drive you home. Generally, cataract surgery patients do not experience any pain after surgery, Dr. Shetty says.

“There may be some itching or discomfort for the first few days, and you may need to wear an eye patch or protective shield on the day of surgery,” Dr. Shetty says. “Also, avoid bending at the waist or lifting heavy objects over five pounds for the first week after surgery.”

The recovery time is short. You will begin to see the results in your vision in the first few days and should make a full recovery within four to six weeks. Many patients report clear vision within several hours. But each person heals differently, according to Dr. Shetty, and you may need a week or two before you see images in their sharpest focus. Your recovery should be completed in about a month, when the eye is healed.

See Better Than Ever

Today, cataract surgery offers patients the opportunity to not only restore their vision, but to possibly see better than they ever have. It can reduce dependency on glasses and make daily activities such as reading and driving easy again.

“We do what we do because we can improve people’s lives,” Dr. Shetty says. “You lose so many faculties and abilities as you age – skills you didn’t realize you were losing, your energy, how fast you think and run. But here’s one area of your life you can actually improve upon. You can see better, function better and do things you haven’t done in years. These are truly phenomenal results.”

Eye surgeons recommend that patients aged 60 and older have a comprehensive dilated eye exam at least once every two years. In addition to cataracts, your eye care professional can check for signs of age-related macular degeneration, glaucoma and other vision disorders.

Article and photo submitted by Florida Eye Specialists.

Heal Your Headaches

Two-part treatment relieves neck pain, chronic migraines.

In early April, not long after the coronavirus began to spread wildly across the United States, the National Institutes of Health launched a study to determine how many people became infected by the virus before anyone really knew what it was.

Photo by Nerissa Johnson.

Robert Palmer

For more than 12 years, guiding the NIH through its decision to launch such studies was a task that belonged to Robert Palmer, who once owned a consulting firm that specialized in organizational development in the Washington, DC, area.

“My specialty was working with not-for-profit and large multinational organizations,” Robert says. “If they had a pain point, they’d contact me, and I’d go in, diagnose the problem, figure out how to fix it and then help them do it.

“During my career, I was fortunate to work with many of the agencies inside the United Nations, including the World Health Organization and the National Institutes of Health, which was my biggest client for about 12 years.”

While advising a smaller client, Robert visited Florida for the first time some 20 years ago. He loved the climate so much that he moved here shortly thereafter, but life in the Sunshine State has not always been sunny for this active 76-year-old retiree.

Twice in the past 12 years, he has been badly injured in accidents that occurred while riding his bicycle. The first incident resulted in Robert undergoing neck fusion surgery. The second resulted in work being done on his lower back.

Throw in that arthritis has developed throughout his spine since the accidents and he has suffered from migraine headaches since childhood, and Robert has spent most of the past decade in debilitating pain.

“I had to give up riding a bike because it actually made my back worse,’’ Robert explains. “Because of the vibration and the jarring movement that came with riding a bike, I’d finish up a ride and just be miserable afterward.

“There were times when the pain was so bad that I almost couldn’t walk and a couple of times when I wound up in the emergency room because the pain was so bad that I couldn’t sit or stand or even lie down.

“As for the headaches, they’re genetic. My maternal grandmother had one on her 100th birthday. I started getting them when I was an adolescent. They diminished a bit when I was in my 20s and 30s, but they came back with a vengeance when I was in my late 40s.

“I could tell when one was coming on because the first thing I noticed was that I would get sick to my stomach. Then my speech would become slurred, and sometimes I’d see what I call fireworks. That’s what they look like. I see them inside my head. It’s these flashes that are just like fireworks going off. But between the slurred speech and nausea, I know a headache is coming on.

“I tried everything I could think of to get rid of them, even acupuncture and Chinese therapies, and when triptans first came out in the 1990s, I was one of the first to start using them, and they’ve helped a lot.

“They’ve sort of allowed me to manage things over the years. Thankfully, I have a high tolerance for pain because I’ve really had to just kind of learn to function with these headaches as well as with the back pain.”

But a functional life is not the same as a rewarding life. As a result, Robert has continually sought relief for his pain. He finally found it at McGreevy NeuroHealth in St. Augustine, the practice of Kai McGreevy, MD, DABPN, RPVI.

A board-certified neurologist and interventional pain management specialist, Dr. McGreevy also has an office in Palm Coast. Robert discovered Dr. McGreevy through his primary care physician shortly after McGreevy opened his practice several years ago.

Flashes of Fireworks

“When Robert came to us, he was suffering with chronic headaches,” Dr. McGreevy remembers. “They initially started as episodes with discrete beginnings and endings, but over the course of years, they turned into daily headaches. The condition was in the context of a history of migraines.

“Robert described his migraines as one-sided, throbbing head pain accompanied by nausea and sensitivity to light and loud sound. The pain worsened with head movement to a point that even his hair hurt and his scalp was very sensitive. The headaches were disabling, and Robert tried various preventive medications, but none sufficiently reduced the frequency or intensity of his headaches.”

Dr. McGreevy began his evaluation of Robert’s condition with a full history and complete neurological examination. He also ordered imaging tests of Robert’s neck and head, and through those tests he was able to rule out a brain tumor, or some other mass or aneurysm.

“But during my exam, I noted a tenderness behind Robert’s head in the region of the occipital nerves,” Dr. McGreevy reports. “He also exhibited something called a Tinel sign. When I tapped over the base of his skull, he felt a brief electrical sensation on top of the nerves in question.

“It became quite obvious that Robert had a condition more complicated than simple migraines. He was suffering from occipital neuralgia that transformed into chronic migraines. I recommended BOTOX® as a treatment for this condition.”

“Dr. McGreevy is a very good diagnostician,” Robert relates. “He’s very thorough and meticulous in the testing that he does and in the comprehensiveness of his evaluations. So when he said, What about BOTOX? I said, Sure, fine. And it’s been a godsend.”

Little Injections

BOTOX is a treatment for patients who have chronic headaches, meaning they have at least 15 headache days per month, or for those who suffer from at least eight migraines per month, McGreevy explains.

“BOTOX treatment is a series of injections designed to reduce the electrical sensation around the occipital nerves and relax the muscles of the scalp and head,” the neurologist notes. “It also relaxes the neck muscles where they insert on the back of the scalp.”

The exact way BOTOX works remains unclear, but it’s believed that it enters the nerve endings and blocks the release of chemicals that are involved in pain transmission. This prevents the brain from triggering pain pathways.

“In Robert’s case, we are able to treat his cervical spinal arthritis as well as his occipital headache pain simply by targeting the appropriate cervical nerves.” – Dr. McGreevy

“The BOTOX treatments involve a series of little injections above my eyebrows and up my forehead,” Robert relates. “They’re placed all around my head, then Dr. McGreevy ends up at the top of my spinal column. And the injections are well worth it.”

“As a result of the BOTOX treatments, Robert experienced a dramatic reduction in frequency and intensity of his headaches, a reduction in migraines specifically, and a reduction in nausea, light sensitivity, phonophobia and scalp sensitivity,” Dr. McGreevy elaborates. “As a result of that, he was able to function better.”

But occipital neuralgia wasn’t the only problem Dr. McGreevy discovered during his examination of Robert.

“Robert also had cervical spondylosis, which is the wear and tear on the neck joints due to osteoarthritis,” Dr. McGreevy expounds. “This complicates the occipital neuralgia and migraines, so we complemented Robert’s BOTOX therapy using another treatment called radiofrequency ablation, or RFA, which concentrates on the nerves of his upper cervical facet joints.

“Radiofrequency ablation helps to stabilize the cervical spondylosis that produces occipital head pain. The goal is to target the source of the head pain, which ultimately leads to relief of migraines and chronic daily headaches.”

The Best Fit

RFA has long been used for the treatment of arthritis neck pain, and today’s pain management specialists have tailored it to treat pain patterns radiating from the neck up into the head or down into the shoulders and arms. RFA can now be customized to address various pain syndromes, their signs and symptoms.

Photo by Nerissa Johnson.

BOTOX
treatments are helping alleviate Robert’s chronic migraines.

“What is unique about radiofrequency ablation is that it does not involve steroids, it is long-lasting and it can treat multiple problems at once,” Dr. McGreevy notes. “So in Robert’s case, we are able to treat his cervical spinal arthritis as well as his occipital headache pain simply by targeting the appropriate cervical nerves.”

Before proceeding with RFA, Dr. McGreevy conducts a diagnostic nerve block, also called a medial branch block, which is an injection of pain-relieving lidocaine under local anesthetic. The purpose of the medial branch block is to further confirm that the pain is being generated by the suspected joints and nerves. It proves the suitability of RFA as a treatment.

“Robert received dramatic pain relief, greater than 80 percent, following each diagnostic injection,” Dr. McGreevy recalls. “That allowed us to proceed with radiofrequency ablation as a definitive treatment for his cervical arthritis.”

RFA is often used for patients who have not received sustained pain relief from other treatments, including epidural steroid injections, facet joint injections and nerve blocks. In many cases, RFA is the best fit to improve patients’ pain control, range of motion and quality of life.

RFA is a minimally invasive, nonsurgical, outpatient procedure during which patients remain awake but are lightly sedated to minimize discomfort and reduce anxiety. Doctors consider it highly effective in temporarily reducing the kind of severe back and neck pain that plagues nearly two-thirds of the world’s population.

During RFA, radio waves are used to produce heat that is delivered through a probe to a group of specified spinal nerves. The heat creates a lesion, or wound, on the nerve tissue that interferes with the transmission of pain signals to the brain, thereby reducing discomfort in the troubled area.

By targeting and damaging the specific nerves responsible for carrying pain signals, RFA can effectively reduce or eliminate a patient’s pain for a few months or even years.

“There are many chronic pain conditions that respond well to radiofrequency ablation,” Dr. McGreevy asserts. “These include spinal arthritis and spine degeneration, as well as pain after spine surgery.”

Dr. McGreevy details the steps of the RFA procedure: “When we are doing the radiofrequency ablation procedure, the patient lies on a table on their belly, and an x-ray camera is used to take pictures of the region we are working on,” he describes. “That is how we can see all the landmarks we need to safely perform the procedure.”

A local anesthetic is then administered to the skin and deeper tissues to provide comfort so that a needle can be inserted and directed toward the targeted nerves. When the needle is precisely positioned, a stylet is pulled out of the needle and replaced by a thin probe.

“Today’s treatments are very advanced. There are options available now that never existed 20 or 30 years ago, and Dr. McGreevy is on top of all of it.” – Robert

“The probe is directed to the targeted nerve, and a radiofrequency generator is turned on,” Dr. McGreevy continues. “That generator provides 120 seconds of radiofrequency waves, or energy, that are delivered to the targeted nerve and create the lesion that cauterizes the nerve.”

When the nerve is cauterized, it can’t send pain signals, so nothing is received and interpreted by the brain. Subsequently, no return message to feel pain is sent back to the affected area of the body.

“Using radiofrequency ablation, Robert received a 50 to 75 percent reduction in pain consistently over the course of nine to 12 months,” Dr. McGreevy states. “He had dramatic improvement in his occipital headaches as well.”

Garden Sanctuary

For nearly 12 years, Robert has lived with neck pain from spinal arthritis that began following the accidents on his bicycle. But he now understands how, over time, the arthritis has affected the chronic headaches and migraines he’s suffered since his youth.

“Dr. McGreevy explained to me that if I get a migraine I’m also going to get an occipital headache, and those are caused by the arthritis and its pinching of the nerves in my neck,” Robert states. “So, I can have occipital headaches, cluster headaches and migraines all at the same time. But if we stay on top of the headache situation, I can live with it.”

Actually, Robert says that he feels better now than he has in a long time.

“That’s absolutely true,” he agrees. “And my treatment is on a schedule now. About the time that the RFA wears off, it’s time to go back. The BOTOX takes about a week to kick in, then there’s an immediate diminishing of the pain level. The relief lasts for about 80 days, which is great because I can get the treatment every 91 days.”

Without the neck pain and headaches, Robert can participate in his favorite hobby, which is gardening, without restriction.Photo by Nerissa Johnson.

“I have a gorgeous garden,” he boasts. “Everyone in town knows about it. Because this is a tourist town, many people walk by my garden and ask questions such as, What’s that thing? What’s that blooming? And I let them take pictures.

“My garden is a sanctuary of sorts for butterflies, bees and hummingbirds. I provide whatever they need to thrive. Take a butterfly, for example. The adults need nectar flowers to feed on but a different kind of plant to lay their eggs on. When the eggs hatch, they feed on those plants before they turn into a chrysalis and become a butterfly.”

Were it not for Dr. McGreevy, Robert might not be as active in his garden. That’s why he’s grateful for Dr. McGreevy and his staff and why he’s quick to recommend the doctor to others needing a neurologist or pain management specialist.

“Dr. McGreevy is young and knows about all the new research,” Robert describes. “Today’s treatments are very advanced. There are options available now that never existed 20 or 30 years ago, and Dr. McGreevy is on top of all of it.

“And he’s a nice guy, too. He has a nice bedside manner. He also has a great staff at McGreevy NeuroHealth. They’re all very well-trained, so it’s not just him.
Dr. McGreevy surrounds himself with good people, which is why I’ve sent a number of people to him.”

Coronavirus and the Eyes

Researchers continue to discover new ways that SARS-CoV-2, the virus that causes COVID-19, affects the body as a whole. While COVID-19 is primarily a respiratory illness, even the eyes are not spared from its effects.

“Most people realize that the coronavirus can cause fever and cough, but we are learning that it can also affect a number of other organ systems, including the eyes,” elaborates Jonathan A. Staman, MD, a board-certified, fellowship-trained retina specialist at Florida Retina Institute.

“Eye manifestations are more commonly seen in patients with more severe systemic disease,” the doctor continues. “Some case reports suggest that up to 30 percent of patients affected by COVID-19 have eye symptoms. Other studies have found eye involvement to be much less frequent and present in only 1 to 3 percent of those infected.”

COVID-19 has been linked to the development of an infectious eye condition called conjunctivitis, also known as pink eye. Conjunctivitis is inflammation of the clear surface of the eye, or conjunctiva, which can result in red, inflamed, swollen eyes.

“While COVID-19 can cause pink eye, it is very important to remember that most pink eye is not due to the coronavirus,” Dr. Staman stresses. “Allergies and other viruses are much more common causes. COVID-19 becomes more of a concern if the patient additionally has systemic symptoms such as fever, cough, shortness of breath, fatigue, or loss of smell or taste, on top of the red, teary, irritated eyes seen with pink eye.

“Because your typical viral pink eye is highly contagious and can be transmitted by tears, patients with pink eye should try not to touch their eyes. If they do, they should wash their hands right away,” Dr. Staman notes.

Conjunctivitis will usually go away on its own within a week or two, but if symptoms are severe or last longer than that, affected people should see their general eye doctor to make sure they don’t have a more serious eye problem.

In The Air Tonight

COVID-19 is typically spread through respiratory droplets that are released into the air when an infected person talks, coughs or sneezes.

“People can become infected with COVID-19 if these droplets are inhaled or also if they land on a surface that they touch with their hands then proceed to touch their mouth, nose or eyes,” Dr. Staman explains. “This is why everyone is being asked to clean their hands frequently and try to avoid touching their nose, mouth and eyes.

“Not only can the infection be spread to the eyes through hand-to-eye contact, but it can also potentially work in reverse. Since the virus has been found in tears, people who rub their eyes and then touch a public surface can potentially transmit the virus to others. Fortunately, the viral prevalence in tears is very low, so this would be an uncommon way for the virus to spread.”

The eyes have also been identified as a potential target for coronavirus in part due to the fact that the eyes have ACE-2 receptors that can be used by the virus to bind to cells.

“These receptors are also found in the respiratory tract and are believed to be a gateway for the virus to enter the body,” Dr. Staman elaborates. “Still, there remains only limited evidence of systemic transmission via the eyes, and this mode of transmission remains much less likely than that via the respiratory tract.”

It is not well understood why some people with COVID-19 suffer mild disease while others are more severely affected. Individuals older than 60 and people with compromised immune systems are typically affected more severely.

“While COVID-19 can cause pink eye, it is very important to remember that most pink eye is not due to the coronavirus. Allergies and other viruses are much more common causes.” – Dr. Staman

“The current estimates are that over a third of coronavirus patients are asymptomatic, and 40 percent of disease transmission occurs before someone feels sick,” Dr. Staman notes. “This reinforces the importance of wearing masks when people are in public and unable to socially distance.

“Whether you are symptomatic or not, by wearing a mask you help protect everyone around you from being exposed to your germs.”

Researchers continue to search for answers to the COVID-19 mystery. In the meantime, Dr. Staman has a suggestion for lowering the risk of eye infection for contact lens wearers.

“Given that we want to minimize how often people touch their eyes, I recommend that most contact lens wearers consider switching to glasses for a while,” the doctor relates. “This will keep patients from touching their eyes while putting in or taking out their contacts. Wearing glasses can also act as a reminder to not touch their eyes.

“Glasses can also serve as a partial barrier to potentially protect the eyes from the aerosolized infectious respiratory droplets.”

Timely Treatment

Most medical practitioners postponed non-urgent medical visits for several weeks during the early COVID-19 pandemic. Most medical offices have now reopened, but the process for office visits may look somewhat different as providers incorporate recommended safety protocols.

“Our practice and many others have incorporated strict disinfection and hygiene precautions so that we can continue to treat patients in a manner that is safe for them and for our staff,” Dr. Staman underscores.

“At Florida Retina Institute, we treat many urgent conditions such as retinal tears, retinal detachments and conditions such as diabetic retinopathy and wet macular degeneration that require timely treatment. Postponing this type of care could leave patients with permanent vision loss and we are not going to let that happen. We always remain available for these patients.”

Back in Bloom

Ablation relieves lumbar arthritis, allowing return to garden sanctuary.

In early April, not long after the coronavirus began to spread wildly across the United States, the National Institutes of Health launched a study to determine how many people became infected with the virus before anyone really knew what it was.

Photo by Nerissa Johnson.

Robert Palmer

For more than 12 years, guiding the NIH through its decision to launch such studies was a task that belonged to Robert Palmer, who once owned a consulting firm that specialized in organizational development in the Washington, DC, area.

“My specialty was working with not-for-profit and large multinational organizations,” Robert says. “If they had a pain point, they’d contact me, and I’d go in, diagnose the problem, figure out how to fix it and then help them do it.

“During my career, I was fortunate to work with many of the agencies inside the United Nations, including the World Health Organization and the National Institutes of Health, which was my biggest client for about 12 years.”

While advising a smaller client, Robert visited Florida for the first time some 20 years ago. He loved the climate so much that he moved here shortly thereafter, but life in the Sunshine State has not always been sunny for this active 76-year-old retiree.

Twice in the past 12 years, he has been badly injured in accidents that occurred while riding his bicycle. The first incident resulted in Robert undergoing neck fusion surgery. The second resulted in work being done on his lower back.

Throw in that arthritis has developed throughout his spine since the accidents and he has suffered from migraine headaches since childhood, and Robert has spent most of the past decade in debilitating pain.

“I had to give up riding a bike because it actually made my back worse,’’ Robert explains. “Because of the vibration and the jarring movement that came with riding a bike, I’d finish up a ride and just be miserable afterward.

“There were times when the pain was so bad that I almost couldn’t walk and a couple of times when I wound up in the emergency room because the pain was so bad that I couldn’t sit or stand or even lie down. Thankfully, I have a high tolerance for pain, because I’ve really had to just kind of learn to function with the headaches and back pain.”

But a functional life is not the same as a rewarding life. As a result, Robert has continually sought relief for his pain. He finally found it at McGreevy NeuroHealth, the St. Augustine practice of Kai McGreevy, MD, DABPN, RPVI.

A board-certified neurologist and interventional pain management specialist, Dr. McGreevy also has an office in Palm Coast. Robert discovered Dr. McGreevy through his primary care physician shortly after McGreevy opened his practice several years ago.

“When Robert came to us, he reported localized pain in his spine, particularly in his lower back,” Dr. McGreevy recalls. “The pain was worse in the morning and was associated with stiffness and rigidity of the spine.

“Robert’s low back pain became worse with extension and rotation of the spine. It eventually became so severe that it limited his walking and, ultimately, his ability to function on a daily basis.”

Dr. McGreevy began his evaluation with a complete neurological evaluation, including an MRI of Robert’s back. Dr. McGreevy determined Robert suffered from lumbar spondylosis, a wear and tear of the joints of the lower spine due to osteoarthritis.

“Robert’s MRI confirmed that his issue was with his lumbar facet joints,” Dr. McGreevy says. “This is an extremely common problem, one of the most frequently seen in our neurology and pain management clinic.

“Low back pain is one of the most common reasons patients visit their primary care physicians and is a leading cause of disability in the United States.”

After examining Robert, reviewing his imaging and performing diagnostic testing, Dr. McGreevy decided that a procedure called radiofrequency ablation, or RFA, was the best option for relieving his low back pain.

The Best Fit

RFA has long been used to treat arthritis pain, and pain management specialists have tailored it to treat pain patterns radiating from the low back into the pelvis and hips, or into the legs and feet. RFA treatment can be customized to address various pain syndromes and symptoms.

Photo by Nerissa Johnson.

RFA treatments allowed Robert to resume his active lifestyle.

“What is unique about radio-frequency ablation is that it does not involve steroids, it is long-lasting and it can treat multiple problems at once,” Dr. McGreevy notes. “In Robert’s case, we are able to treat his low back pain simply by targeting the appropriate lumbar nerves.”

Before proceeding with RFA, Dr. McGreevy conducts a diagnostic nerve block, also called a medial branch block, which is an injection of pain-relieving lidocaine under local anesthetic. The purpose of the medial branch block is to confirm that the pain is being generated by the suspected joints and nerves. It proves the suitability of RFA as a treatment.

“Robert received dramatic pain relief, greater than 80 percent, following each diagnostic injection,” Dr. McGreevy recalls. “That allowed us to proceed with radiofrequency ablation as a definitive treatment for his lumbar arthritis.”

RFA is often used for patients who have not received sustained pain relief from other treatments, including epidural steroid injections, facet joint injections and nerve blocks. In many cases, RFA is the best fit to improve patients’ pain, range of motion and quality of life.

RFA is a minimally invasive, nonsurgical, outpatient procedure during which patients remain awake but are lightly sedated to minimize discomfort and reduce anxiety. Doctors consider it highly effective in temporarily reducing the type of severe back and neck pain that plagues nearly two-thirds of the world’s population.

During RFA, radio waves are used to produce heat that is delivered through a probe to a group of specified spinal nerves. The heat creates a lesion, or wound, on the nerve tissue that interferes with the transmission of pain signals to the brain, thereby reducing discomfort in the troubled area.

“There are many chronic pain conditions that respond well to radiofrequency ablation,” Dr. McGreevy asserts. “These include spinal arthritis and spine degeneration, as well as pain after spine surgery.”

Dr. McGreevy details the RFA procedure: “When we are doing the radiofrequency ablation, the patient lies on a table on his or her belly, and an x-ray camera is used to take pictures of the region we are working on,” he describes. “That is how we can see all the landmarks we need to safely perform the procedure.”

A local anesthetic is then administered to the skin and deeper tissues to provide comfort so that a needle can be inserted and directed toward the targeted nerves. When the needle is precisely positioned, a stylet is pulled out of the needle and replaced by a thin probe.

“The probe is directed to the targeted nerve, and a radiofrequency generator is turned on,” Dr. McGreevy continues. “That generator provides 120 seconds of radiofrequency waves, or energy, that are delivered to the targeted nerve and create the lesion that cauterizes the nerve.”

When the nerve is cauterized, it can’t send pain signals, so nothing is received and interpreted by the brain. Subsequently, no return message to feel pain is sent back to the affected area of the body.

By targeting and damaging the specific nerves responsible for carrying pain signals, RFA can effectively reduce or eliminate a patient’s pain for a few months or even years.

“Using radiofrequency ablation, Robert received substantial relief from his low back pain that lasted approximately 12 months,” Dr. McGreevy reports. “Sometimes, the facet nerves grow back slowly, and if the pain returns in the same fashion but not to the same degree, we can repeat the procedure. We’ve treated Robert several times over three years.”

Garden Sanctuary

For nearly 12 years, Robert lived with back pain from spinal arthritis that began following his bicycle accidents. But he says that he feels better now than he has in a long time.
“That’s absolutely true,” he agrees. “And my treatment is on a schedule now. About the time that the RFA wears off, it’s time to go back.”

Without the back pain, Robert can participate in his favorite hobby, which is gardening, without restriction.

“Dr. McGreevy surrounds himself with good people, which is why I’ve sent a number of people to him.” -Robert

“I have a gorgeous garden,” he boasts. “Everyone in town knows about it. Because this is a tourist town, many people walk by my garden and ask questions such as, What’s that blooming? And I let them take pictures.

“My garden is a sanctuary of sorts for butterflies, bees and hummingbirds. I provide whatever they need to thrive. Take butterflies, for example. The adults need nectar flowers to feed on but a different kind of plant to lay their eggs on. When the eggs hatch, they feed on those plants before they turn into a chrysalis and become butterflies.”

Robert is grateful to Dr. McGreevy and his staff and is quick to recommend the doctor and his practice to others needing the care of a pain management specialist.

“Dr. McGreevy is young and knows about all the new research,” Robert describes. “Today’s treatments are very advanced. There are options available now that never existed 20 or 30 years ago, and Dr. McGreevy is on top of all of it.

“And he’s a nice guy, too. He has a nice bedside manner. He also has a great staff at McGreevy NeuroHealth. They’re all very well-trained, so it’s not just him. Dr. McGreevy surrounds himself with good people, which is why I’ve sent a number of people to him.”

Winning Adjustments

Technique to align atlas vertebra relieves headaches, other ailments.

Candi Walker has always lived a very active lifestyle. As a youth, she rode and showed horses. She was also a competitive ice skater. Over the years, though, those activities took a toll on her body. Photo courtesy of Candi Walker.

In addition to general pain and soreness, she has suffered from debilitating headaches that started when she was 12 years old after a fall from her horse nearly left her paralyzed.

“I have been to several neurologists over the years and on many different pain medications, but none of them provided permanent relief,” Candi laments. “Part of the problem, of course, was that I was only putting a Band-Aid on the situation.

“That went on for years until a friend suggested I see a chiropractor. So, 35 years ago, I started to receive atlas orthogonal procedures – basically, an alignment of the atlas vertebra, which is the uppermost vertebra in the neck.

“That was the only thing that managed my pain. I started those treatments when I lived in Atlanta, and when I moved to Sarasota, I found Stephen R. Zabawa, DC, at Atlas Chiropractic of Sarasota.”

The Atlas Procedure

An upper cervical chiropractor, board-certified in orthospinology, Dr. Zabawa uses gentle, precise adjustment protocols, including the atlas orthogonal technique, to treat misalignments of the spine.

The atlas adjustment procedures seek to maintain the precise alignment of the atlas vertebra, which is essential to good health. Misalignment of the atlas vertebra causes the spine to twist in an attempt to maintain balance.

This twist can pinch nerves and put pressure on the spinal cord or brain stem. In turn, the pressure can cause a variety of symptoms and problems, many of which can appear to be unassociated with the cervical spine.

To determine whether a person is suffering from misalignment of the atlas vertebra and is a candidate for the atlas procedure, Dr. Zabawa begins by performing a complete examination of the patient to check for subluxation.

Subluxations are often deceiving, however. Though symptomatic pain may appear in the lower back, legs, shoulders, arms or other parts of the body, the cause is very often located in the cervical spine.

“Subluxation is just a big word meaning that two bones are out of position and you have nerve pressure,” Dr. Zabawa explains. “If there is subluxation and we determine that a patient is a good candidate for the atlas procedure, we then take a series of extremely detailed, 3D x-rays.

“Since the adjustment is highly precise, the measurements we take and the analysis we make are also meticulous. When I know the exact angle at which a patient is misaligned, I know how to adjust them.”

Dr. Zabawa utilizes a light-force method of adjusting the cervical spine. This extremely gentle method delivers a precise, effective adjustment that takes pressure off the spinal cord.

“Unlike other chiropractors, I do not snap-crackle-pop you,” Dr. Zabawa explains. “Here, you lie on your side and, using one instrument, I gently realign your whole spine. It is that gentle adjustment that makes the upper cervical chiropractic unique.

“Regular upper cervical adjustments have helped me through sports injuries and stressful events all my life.” – Candi

“An upper cervical correction is very controlled so there is no pulling or jerking of such a delicate area. It’s so gentle that it almost feels like a puff of air touching you. This very gentle touch makes a very powerful correction.”

The instrument Dr. Zabawa uses to correct an imbalance of the atlas bone is a handheld device called a Laney instrument. The instrument works by delivering an extremely small but fast tap that produces enough force to realign the bone.

“It only hits once and produces quite a force,” Dr. Zabawa explains. “It is a force that you really cannot feel, but it is there. It goes through the soft tissue, through the muscle, to the bone. It moves the bone and takes the pressure right off the nervous system.”

The doctor determines precisely where to deliver this force based on the 3D x-rays he takes. Similar to how a professional pool player lines up a shot based on angles and trajectory, Dr. Zabawa compiles information about the spine to determine the angle needed.

“I get a 3D picture of how a patient is misaligned, so I know the exact angle to come in and correct it,” he assures. And by adjusting the upper cervicals, I’m actually adjusting the full spine, including the pelvis and sacrum.

“Once the spine, head and neck have returned to their proper positions, interference is removed. That takes pressure off the nervous system, and by removing that pressure, balance is restored to the body. It is an effective approach without any extreme manipulations.”

Body, Heal Thyself

Dr. Zabawa emphasizes that the atlas adjustments can help relieve symptoms from many different ailments, including bed-wetting, digestive disorders, asthma and even high blood pressure.

Photo courtesy of Candi Walker.

Candi lives a much more active lifestyle, thanks to the atlas adjustments.

“The human body has an amazing ability to heal itself,” Dr. Zabawa reminds. “But nerve interference can cause many problems and hinder healing. By aligning the bones of the upper neck – adjusting the upper cervicals – pressure is taken off the spine and nerves. When you take pressure off the nervous system, the body begins to heal.”

Candi can attest to that. She has given up showing horses and hung up her ice skates, but thanks to Dr. Zabawa and his upper cervical adjustments, she now enjoys the quality of life she once struggled to gain.

“Stress is another thing that my body does not handle well,” Candi reports. “Everyone has stress, which affects the body in many ways, including misalignment. But regular upper cervical adjustments have helped me through sports injuries and stressful events all my life.

“That’s why I am so happy to have found noninvasive, non-medication relief. I go regularly for my adjustments to keep things aligned and balanced. It’s just that easy, and
Dr. Zabawa is fantastic. He’s very gentle, yet accurate and precise.

“The staff at Atlas Chiropractic of Sarasota is exceptional, as well. They are all so professional and accommodating. They really do provide top-notch care there.”

Men: Is Low T Slowing You Down?

June 2nd, 2020

Hey guys, are you feeling sluggish, having trouble building muscle through your workouts or experiencing a slowdown in the bedroom? You could have low testosterone, or low T. Low T is a condition in which the male reproductive glands, the testes, don’t produce enough of the hormone testosterone.

Image: Zerbor/Dreamstime

When you think of testosterone, what comes to mind? Macho men? Aggressive, impatient, type A behavior? Road rage? Violence?

Testosterone is necessary for male development and sexual function. It’s also responsible for building muscle and bone mass in men as well as for sperm production and sex drive. In addition, testosterone has an effect on male fat distribution, bone density and red blood cell production.

In healthy men, testosterone levels peak during their early to mid-thirties, then they slowly decline as a normal part of the aging process. A man’s testosterone level typically declines by about one percent a year as he gets older.

Marginally lower testosterone levels are normal as men get older, but there are certain factors that can cause you to have a more significant underproduction or lack of production of testosterone. The causes low testosterone include:

  • Injury or infection of the testes
  • Chemotherapy for cancer
  • Medications such as opioids, hormones to treat prostate cancer and steroids such as prednisone
  • Acute or chronic illness
  • Alcohol abuse
  • Obesity or extreme weight loss
  • Uncontrolled type two diabetes
  • Severe hypothyroidism
  • Previous anabolic steroid use

Among the most troublesome symptoms of low T are decreased sex drive and erectile dysfunction (ED). ED is the inability to achieve or maintain an erection suitable for sexual activity. There are other symptoms of low T that you may notice and some that are going on inside your body that you don’t notice. Symptoms of low T include:

  • Decreased sense of wellbeing
  • Depressed mood
  • Difficulty concentrating and remembering
  • Fatigue
  • Moodiness and irritability
  • Loss of muscle strength
  • Decrease in body hair
  • Breast development
  • Changes in sleep patterns
  • Decrease in hemoglobin in the blood
  • Thinning of the bones
  • Increased body fat
  • Infertility

Your doctor can diagnose low T by taking a blood test to measure the amount of testosterone in your blood and correlating that with your symptoms. It may take several measurements of your testosterone level because levels change throughout the day. They tend to be highest in the morning, so your doctor will likely order the blood test to be performed at that time.

The treatment for low T is testosterone replacement therapy, or TRT. There are several methods for delivering the testosterone including intramuscular injections, transdermal patches, gels and pellet therapy.

TRT is typically effective at increasing bone density, providing greater muscle strength and physical performance, and improving mood and sense of wellbeing, sexual function and mental sharpness.

But TRT can result in some side effects as well. These include acne or oily skin, swelling of the ankles caused by mild fluid retention, urinary symptoms caused by stimulation of the prostate, breast enlargement or tenderness, worsening of sleep apnea, overproduction of red blood cells, decrease in testicle size and skin irritation.

In January, the American College of Physicians (ACP) released new clinical guidelines for providing TRT to adult males with age-related low T. The evidence-based recommendations, which were published online on January 6 in Annals of Internal Medicine, highlight data from a systematic review of evidence on the safety and efficacy of TRT in that population.

The ACP recommendations suggest that clinicians should initiate TRT in adult males with age-related low T to help them improve their sexual function. The ACP also recommends that clinicians should avoid prescribing testosterone for any other concern, including depressive symptoms, low energy and decreased vitality.

In addition, the ACP recommends that clinicians reassess men’s symptoms within 12 months of initiating testosterone treatment, with regular re-evaluations during subsequent follow-up appointments. They should discontinue TRT if sexual function fails to improve.

For the most part, the ACP’s recommendations mirror the guidelines proposed by the Endocrine Society and the American Urological Society.

In any case, you should discuss the risks and benefits of TRT with your physician before beginning treatment. And it’s critically important that you be honest with your provider about your symptoms. Don’t be embarrassed. There’s help for you, but you have to open up to your provider. Do it today!

Relieve, Repair and Restore

Regenerative therapies return former athlete to active lifestyle.

Frank DeLauro was very active and athletic during his youth. A high school football player and wrestler, he earned a scholarship in those sports from Hofstra University in New York. Frank also participated in taekwondo at a competitive level, but later in life, those physically demanding activities caught up with him.

Photo courtesy of Frank DeLauro.

Frank DeLauro

“I developed debilitating arthritis,” shares Frank, now 72. “It’s actually in my family history. My grandmother was bedridden with arthritis back in the ’30s; my father inherited it, and my aunts and uncles all have it. With me, playing sports exacerbated the arthritis, which can be unbelievably limiting.”

When Frank, a Hoboken, New Jersey, native, was 55, his condition progressed significantly into both of his hips. To maintain the level of activity he enjoyed at the time, Frank underwent bilateral hip replacement surgery.

“I had a great surgeon,” Frank reports. “He worked on Bo Jackson, the professional football and baseball player. And just like it did with Bo Jackson, my treatment turned out wonderfully.”

For 10 years after the hip surgeries, Frank continued to manage his severe neck and back pain. In 2010, his condition became so painful and debilitating that Frank was declared totally disabled.

“At that point, I was in a wheelchair most of the time,” Frank recalls. “I could walk but I needed a cane and could go no more than 200 feet. I couldn’t stand for more than five minutes either, so I wasn’t very active.”

Frank’s condition continued to worsen, and he soon began suffering knee, shoulder and back pain that made everyday tasks unbearable. Desperate for relief, Frank sought help from another orthopedic surgeon.

That physician explained that Frank’s joints and spine were riddled with degenerative osteoarthritis, the most common type of arthritis, and that he was also suffering from stenosis, a narrowing of the spinal canal, and degenerative disc disease.

Unfortunately, the advice Frank received regarding treatment for his pain only made him feel worse. The orthopedic surgeon told him that to become active again, he would need to undergo replacement surgery on his ailing joints and have spinal fusion procedures done on his neck and lower back.

“He told me I needed the spinal fusion if I ever wanted to walk or stand again without pain,” Frank remembers. “I thought, I’m not going through five more major surgeries. There’s got to be another way.”

“Regenerative medicine is a wonderful alternative to going under the knife. It worked wonderfully for me.” – Frank

Overwhelmed, Frank began searching for another solution. Through his own research, he discovered regenerative therapy and initially consulted with Nicole Hadjadj, the director of regenerative treatment with Nona Medical Arts, which has clinics in Merritt Island and Orlando.

“Frank first came to us for a consult wishing to avoid having multiple surgeries,” Nicole reports. “Our first order of business was to treat his neck and lower back, which we treated with a combination of stem cell, platelet rich plasma (PRP) and high-level laser therapy.”

The combination of therapies helped Frank significantly with his debilitating pain and immobility.

“Within a month of starting treatment, I was able to get rid of my cane,” Frank exudes. “After about three months, my neck felt so much better that I could move it rather freely and these clicking sounds that I always heard from my spine were reduced tremendously. After about six months, those clicks were gone completely, and I had full mobility in my neck.”

Primary Mission

At Nona Medical Arts, Nicole works alongside Richard E. Gayles, MD, a board-certified anesthesiologist and pain management specialist. Dr. Gayles is the practice’s founder and medical director. Nona Medical Arts offers comprehensive treatment protocols for patients such as Frank with complicated pain.

“Unfortunately, many regenerative medicine offices have adopted a one-size-fits-all, inject-and-release standard,” Nicole explains. “Rather than utilizing this type of approach, we evaluate each candidate and develop a protocol tailored to each person’s specific problem.

“We pride ourselves on staying at the forefront of the regenerative medicine and pain management field while treating every patient like our only patient. We offer conventional pain management treatment as well as out-of-the-box, regenerative therapies. And we are very big on using a combination of therapies, not just stem cells.”

“We perform various injections if indicated by the patient’s clinical condition,” Dr. Gayles adds. “These include injections into the large joints and spinal injections that range from epidurals to facet blocks to rhizotomy, which targets specific nerve roots. We also perform kyphoplasty to treat vertebral compression fractures.”

Unfortunately, traditional pain management techniques alone do not always alleviate a patient’s pain. It’s in those cases that Dr. Gayles turns to regenerative medicine techniques such as stem cells, PRP and high-energy laser therapies to help repair the source of the pain.

“There are some other cell-based products for the spine and large joints that we utilize,” Dr. Gayles notes. “The use of these additional cell-based products is determined by the patient’s age, health history and chronic pain condition. That’s part of tailoring the treatment for each specific patient.”

Some of the cell-based products that Nona Medical Arts uses include exosomes and placental or cord blood cells.

“Exosomes are extra-cellular vesicles that drive existing stem cells from within the body to the damaged area,” Dr. Gayles educates. “They are filled with growth factors that enhance tissue growth and repair.

“And while we prefer to utilize autologous stem cells, meaning the patient’s own stem cells, that is sometimes not possible. If that’s the case due to advanced age or medical history, that’s when we offer the use of donor placental cell or cord blood cell products in our combination treatment protocols.”

Two-Time Champion

Two years after having his spine treated successfully through regenerative techniques, Frank received a similar regenerative therapy protocol on his shoulders and knees. Those treatments were effective in allowing Frank to avoid undergoing the multiple joint replacement and spine surgeries his doctor had once recommended.

“About nine to 12 months after being treated at Nona Medical Arts, my shoulders felt much better,” Frank reports. “And just as it was with my spine, the pain and clicking in my knees eventually subsided.

“The folks at Nona Medical Arts even gave me some advice on an exercise routine that I follow religiously to this day. I also stretch for an hour and 10 minutes every day and go to the gym three days a week, and I feel great.

“I can walk forever now, and even play bocce ball. I’ve been on two championship teams, and that alone shows the improvement in my spine. You can’t really bend over and throw a bocce ball while sitting in a wheelchair.

“Regenerative medicine is a wonderful alternative to going under the knife. It worked wonderfully for me. My mobility has increased to the point where I was also able to go back to work at Viera East Golf Club as a starter.

“I thank God and the great staff at Nona Medical Arts for giving me back my life.”

Fact or Fiction

Busting myths about cancer risk assessments.

A cancer risk assessment explores an individual’s personal and family health history to determine the individual’s risk for developing cancer. In most cases, having a family history of cancer is what prompts people to seek a cancer risk assessment.

Photo courtesy of Cancer Care Centers of Brevard.

Alice Spinelli, APRN, AOCN

“We begin the assessment by drawing a genogram, called a pedigree, of the person’s first-, second- and third-degree relatives,” describes Alice Spinelli, APRN, AOCN, a board-certified oncology nurse practitioner at Cancer Care Centers of Brevard. “We plot out the relatives’ cause of death and when they passed. We look primarily for the incidence of cancer and the types of cancer.

“If the person being assessed has a small family or little information about their family, there are also computer models available that use algorithms to measure risk. There are algorithms that calculate risk for various types of cancer such as breast and colon cancer. We plot out that information as well.”

The main reason for gathering all of this information is to determine if the individual meets the criteria for genetic testing, if they desire to be tested. It also helps determine which genes to test. If the person’s pedigree is limited, providers might recommend testing a broad array of genes to compensate for the unknowns.

“Cancer risk assessments at Cancer Care Centers of Brevard are more than genetic testing,” Alice observes. “We also consider lifestyle and personal health factors when determining a person’s cancer risk. Unfortunately, there are certain myths about cancer risk assessments that cause some people to be fearful of the process.”

No Wrong Answers

The first myth is that most cancers are hereditary and can, therefore, be detected through genetic testing.

“People are often surprised to learn that most cancers do not develop from a genetic mutation passed down from an individual’s mother or father,” Alice elaborates. “Actually, we think just a little more than 10 percent of cancers are hereditary. The rest, almost 90 percent, occur due to mutations acquired during a person’s lifetime.

“Acquired mutations often occur as the result of aging, certain behaviors such as smoking or environmental factors such as exposure to the sun with skin cancer. In some cases, we do not know what causes the mutations. They simply occur randomly.”
The second myth is that a cancer risk assessment is synonymous with genetic testing.

“That is not true,” Alice asserts. “The purpose of the cancer risk assessment is education. It is a time for people to learn what their cancer risk is, then talk about whether testing is appropriate for them.

“At the end of that visit, I have done my job if I have helped people understand what their options are. They then have a choice to say, I want to get tested; I want to go home and think about it; or Thank you very much, but I do not want to do this. And none of these answers are wrong. Testing is an option.”

People who believe this myth will sometimes schedule a cancer risk assessment, but then cancel it or fail to show up for the appointment.

“After they schedule the appointment, they may talk to friends and relatives who may share other myths about genetic testing,” Alice suggests. “Their friends may say, You will never get health insurance and never get employed if you have a mutation. Your insurance company will drop you. The genetics lab will use your DNA for purposes other than what you intended.

“All of these statements are untrue,” Alice assures. “There is really no reason to fear a cancer risk assessment at Cancer Care Centers of Brevard.”

Warding off Warts

Plantar warts can be painful and embarrassing; don’t let them go untreated.

The most common breeding grounds for verruca plantaris, or plantar warts, are communal showers, floors in public swimming pools and even your shower at home. Breakouts can also occur among people who share gym or athletic facilities or in settings where bare feet are the rule.

“Warts can occur on any compromised skin surface, but they are most common on the bottoms of the feet and hands,” explains Robert P. Dunne, DPM, FACFAS, a board-certified podiatric surgeon at Lake Washington Foot & Ankle, which has offices in Melbourne and Palm Bay.

“They tend to invade the skin through small abrasions or cuts – ones that you may not even realize you have,” the doctor adds. “The plantar wart can be quite painful since you would be putting pressure on the area by simply standing. Paring them down can sometimes relieve some of the pressure, but a more aggressive treatment may be required.”

Lake Washington Foot & Ankle is a comprehensive podiatric medicine clinic where Dr. Dunne treats a wide variety of podiatric complaints, including tinea pedis (athlete’s foot), dermatitis; heel, foot and ankle pain; tendonitis, plantar fasciitis, hammertoes, bunions and other bone issues.

“We treat everything from ingrown toenails to neuromas,” Dr. Dunne explains. “We also do clinical trials for onychomycosis [fungal toenails] in an effort to find better and more effective treatment for this aliment.

“As for treating plantar warts, there are several treatment options, not all of which are invasive. Treatment can be oral, such as Tagamet®; topical, such as salicylic acid or retinoid cream; slightly invasive, such as cryotherapy; or invasive, such as an excision of the wart.

“And while there are several over-the-counter and home remedies that people can try, we strongly caution those who are susceptible to infection or persons with diabetes not to try these without consulting their doctor.”

Plantar Wart Risk Factors

There are many risk factors for plantar warts, especially in our Florida environment.

“Age can be a factor in the development of a wart,” the doctor notes. “Children are more susceptible because they have not built immunity to the virus. Also, people with weakened immune systems are particularly susceptible to the virus.”

Dr. Dunne further warns that warts are contagious, so anyone affected should take precautions to avoid spreading the virus. Prevention measures include: not touching other people’s warts; not sharing towels, shoes or socks; wearing flip-flops in the shower (both at home and in a community-shower setting), covering the wart to prevent exposure; and not scratching or picking at the wart, as this can easily cause it to spread.

“Our patients come first, and we recommend they take action now if they have a problem.”

Article submitted by Lake Washington Foot & Ankle.

Advanced Technology in Cataract Surgery

Options to improve quality of life.

Photo courtesy of Wilma Tucker.

Wilma Tucker

Cataracts are a normal part of aging, but cataract surgery isn’t just for the elderly. A recent study published in the Journal of Cataract & Refractive Surgery found that more middle-aged patients (age 65 and under) are having cataract surgery—and at younger ages.

62-year-old Wilma Tucker was one of the many middle-aged patients who assumed she was too young for cataract surgery, despite the challenges with her sight.

“When I was watching TV, I couldn’t read the type on the screen from where I was sitting on my sofa,” Wilma says.

She knew her vision was changing when she couldn’t spot her friends during a night out.

“I had scanned the restaurant and I was like, Where are they?” Wilma remembers. “Finally, one of them walked up to me and said, We’re over here. I couldn’t find them, even though they were right in front of me.” 

Then Wilma’s twin sister had cataract surgery. Wilma went to see her eye doctor and found out she had cataracts as well.

“I thought I would need to wait years for surgery,” Wilma says. “But I thought it would be wonderful not to have to wear these thick glasses anymore. Once my sister had surgery, I realized I could get it, too.”

Wilma’s optometrist referred her to Rajesh Shetty, M.D., a board-certified and fellowship-trained ophthalmologist at Florida Eye Specialists.

“Now we’re doing cataract surgery at a much earlier age because of safety,” Dr. Shetty explains. “Twenty years ago, the benefit of surgery was comparable to the risk. But thanks to advances in technology, cataract surgery is safer and provides better outcomes than ever, so patients now don’t have to live with impaired vision. We don’t have to wait.”

Time To Act

“A cataract is the clouding of the lens in the eye that affects vision,” says Dr. Shetty. “By age 80, more than half of Americans have been diagnosed with a cataract or have had cataract surgery. However, many of my patients don’t realize that cataracts can begin to develop early, in their forties and fifties.” 

Dr. Shetty says cataracts develop slowly and painlessly over time. In the early stages, symptoms may be so mild that patients don’t realize their vision is changing. But as a person ages, cataracts can grow to the point where they can get in the way of living an active, independent life. 

“Cataracts can affect night vision, meaning you may not be able to drive home from work in the evening,” Dr. Shetty says. “As people continue to work later and later in life, this becomes a big problem for our patients.”

Those with advanced cataracts may also experience symptoms like blurry vision, double vision, sensitivity to glare and light, fading colors, and they may need to change their prescriptions for glasses or contacts more frequently. 

Dr. Shetty explains that younger patients who undergo cataract surgery tend to heal more quickly, resume normal activity more rapidly, and enjoy better vision results. That’s beneficial, since vision needs have become more demanding with advances in technology and today’s active adult lifestyle.

“Vision needs have changed a lot,” Dr. Shetty says. “We spend much more time looking at phones and other devices, with our friends and family communicating with us constantly. We’re traveling more, looking at GPS, driving during dusk, dawn, rain, and nighttime. We’re playing golf and reading. The demand for clear vision at all ages is the highest it’s ever been.”

Next Generation

Wilma had cataract surgery earlier this year and says it was painless.

“The experience at Florida Eye Specialists was exceptional,” she says. “They’re so thorough. They have so much experience. They made me feel very at ease. I was very blessed to have doctors like this available to me.”

Wilma received a type of advanced cataract surgery known as laser cataract surgery. Unlike traditional cataract surgery, where a scalpel is used to make an incision in the eye by hand, laser cataract surgery is computer guided. Dr. Shetty says this results in a safer, gentler procedure. The laser also creates a more precise and accurate outcome. This allows eye surgeons to correct a wide range of vision problems, including astigmatism and far- and near-sightedness at the time of cataract surgery.

Dr. Shetty has had great experience with this procedure. Florida Eye Specialists was the first practice in Northeast Florida to offer laser cataract surgery to patients and has performed nearly 7,000 procedures to date.

In addition to laser cataract surgery, Dr. Shetty says the latest technology in premium cataract surgery are the advances in intraocular lens (IOL) technology. An intraocular lens is the artificial lens that is implanted in the eye during cataract surgery after the eye’s cloudy natural lens has been removed.

While surgeons have been using these lenses for decades, today’s versions offer crisper, higher quality vision and more function than they’ve ever provided before, according to Dr. Shetty.

“Now, we have the ability to correct near, intermediate and far vision at the same time. It’s called trifocal lens technology, and it’s the number one used lens in Europe,” says Dr. Shetty. “The first trifocal lens came out in the U.S. this fall in 2019. We’ve had a great experience with it so far.”

Wilma received a toric multifocal lens, designed for patients with astigmatism.

“It’s just amazing,” Wilma says. “My vision is even better than I expected to have. It’s the best it’s ever been.”

“Wilma was not a good contact lens wearer because of her dry eye and astigmatism,” Dr. Shetty recalls. “It was so great to see her without her glasses. Her smile just lit up, she was thrilled. No glasses, but able to see far and near. She’s an active individual, so that’s important.”

“To wake up in the morning and not have to put my glasses on, it’s been life-changing,” Wilma says.

Like Wilma, many patients have particular vision needs. With the many kinds of intraocular lenses now available, eye surgeons can choose the best fit for each patient.

“At Florida Eye Specialists, our practice focuses on each individual’s needs,” says Dr. Shetty. “As we’ve gotten more sophisticated in our technology, we see patients that need better night vision, patients that have had prior refractive surgery, golfers who may need better vision during daylight. It’s not one size fits all. Now, we can customize the lens to the patient’s lifestyle.” 

Today, cataract surgery offers patients the opportunity to not only restore their vision, but to possibly see better than they ever have before. It can reduce dependency on glasses and make daily activities like reading and driving easy again.

“We do what we do because we can improve people’s lives,” Dr. Shetty says. “You lose so many faculties and abilities as you age, skills you didn’t realize you were losing, your energy, how fast you think and run. But here’s one area of your life you can actually improve upon. You can see better, function better, and do things you haven’t done in years. These are truly phenomenal results.”

Eye surgeons recommend that patients aged 60 and older have a comprehensive dilated eye exam at least once every two years. In addition to cataracts, your eye care professional can check for signs of age-related macular degeneration, glaucoma, and other vision disorders.

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