Cataracts, Cosmetics And More

Advanced techniques and technology support premier care for eyes and face.

Ana-Maria Oliva, MD

Ana-Maria Oliva, MD


Vision is priceless. Believing this to be true, the physicians and staff at Florida Eye Specialists & Cataract Institute are devoted to bringing premier eye care to residents on Florida’s west coast. That has been their unifying mission since 1981.

Florida Eye Specialists & Cataract Institute’s eye specialists in Brandon offer a vast selection of services using the most advanced technology available. This includes employing the latest techniques and products for the treatment of cataracts.

“Cataracts are the clouding of the eye’s normally clear natural lens,” defines Ana-Maria Oliva, MD, a board-certified ophthalmologist and fellowship-trained corneal and refractive surgeon. “Most people develop cataracts in their 60s. Some develop them earlier, some later. Symptoms of cataracts include blurry vision; glare, particularly with oncoming lights in traffic; double vision in one eye; halos; and difficulty reading.

“Cataracts are treated with surgery. During cataract surgery, we remove the cataract and place an intraocular lens implant, or IOL. There are different types of IOLs. Our goal is to select one that will minimize the patient’s dependence on glasses after surgery.”

Cataract surgery has come a long way over the years, and more can be done now to improve the patient’s vision following surgery, Dr. Oliva contends. One advancement is the femtosecond laser, which can be used to perform certain aspects of cataract surgery.

“The femtosecond laser creates the wound that allows us to enter the lens capsule to remove the cataract,” Dr. Oliva describes. “It also softens the lens, breaks it up into small pieces, making it easier to remove the cataract and minimizing the amount of energy required during surgery.”

Typically, cataract surgeons correct the patient’s vision for distance, and the patient will require reading glasses for near vision. One way around this is to correct one eye for distance and one eye for reading. This is called monovision.

“Not everybody is a candidate for monovision, and not everybody can tolerate it,” Dr. Oliva reports. “The other option is to use one of the advanced-technology multifocal IOLs that have become available in recent years.

“One of the most popular multifocal lens options that we offer at our practice is the Alcon PanOptix®, which is a trifocal lens. It corrects for distance, intermediate and reading vision. It does this by splitting the light entering the eye, so patients can utilize the same amount of light to see at all three focal points.”

Unfortunately, when light is split, it can sometimes result in side effects such as halos, starbursts or glare. While these side effects typically improve over time, they can be avoided entirely by utilizing another type of IOL, the AcrySof® IQ Vivity™ lens, also by Alcon. 

“The Vivity is classified as an extended range of vision lens,” Dr. Oliva discloses. “Instead of splitting light, it stretches the light so it can be used to focus on images far away and up close. It’s a little better for intermediate vision than for very close-up vision.

“It’s also a nice option for patients who may not be PanOptix candidates due to preexisting eye pathology. These considerations are taken into account during the patient’s cataract evaluation with the physician.”

Face to Face

Norberto Mancera, MD, is a fellowship-trained oculofacial plastic surgeon at Florida Eye Specialists & Cataract Institute. At the Brandon location, Dr. Mancera and his colleague, Robert J. Applebaum, MD, MBA, address a multitude of complaints concerning the eyes and face.

Norberto Mancera, MD

Norberto Mancera, MD

“Oculofacial plastic surgeons are specialists in treating conditions of the eyelid, eye socket, lacrimal (tear) system and face,” Dr. Mancera explains. “We treat cancer patients requiring reconstructive surgery following tumor removal anywhere on the face. We care for those seeking treatment for tearing issues, eyelid problems and other disorders of the eyes.

“A big niche of patients comes to us for cosmetic procedures. Typically, when people think of cosmetic services, they think of regular plastic surgeons. But they are trained to treat the entire body. Oculofacial plastic surgeons specialize 100 percent on the face and eyes.”

One of the most common surgeries performed by Dr. Mancera and Dr. Applebaum is blepharoplasty, a procedure to correct dermatochalasis, or excess skin on the eyelids.

“It’s a simple procedure that’s performed in the office. We use local anesthesia so patients are very comfortable. During the procedure, we make tiny incisions, remove the excess skin from the eyelid and place a couple of stitches, which are removed a week later. Patients are generally in and out in 30 minutes.”

Many patients arrive at Florida Eye Specialists & Cataract Institute seeking to rejuvenate their face. For this purpose, Dr. Mancera and Dr. Applebaum provide everything from BOTOX® Cosmetic and filler injections to laser treatment and light therapy.

“BOTOX Cosmetic is often the first stage of nonsurgical treatment for aging faces,” Dr. Mancera describes. “BOTOX is a neurotoxin, but at the dosages we use for cosmetic procedures it’s not harmful to humans. 

“We inject BOTOX Cosmetic into the area where nerves are sending chemical messages signaling muscles to contract. Lines and wrinkles form when facial muscles contract and the skin scrunches up. BOTOX Cosmetic cleaves the signal from the nerves so that the muscles don’t get the message to contract.”

Injections of hyaluronic acid fillers such as JUVÉDERM®, VERSA™ and Restylane® have increased in popularity among those seeking facial rejuvenation. Dr. Mancera and Dr. Applebaum often use fillers to increase volume in the cheeks.

“As people age, they begin to lose fatty tissue in the cheeks, causing a hollow, sagging appearance,” Dr. Mancera informs. “Fillers work against this condition by volumizing the hollow areas, which plumps the face and gives it a lift.”

The next stage of nonsurgical treatment for skin rejuvenation is the use of light therapy. Dr. Mancera and Dr. Applebaum treat various facial issues using intense-pulsed light, or IPL.

“IPL uses high-intensity light at multiple wavelengths,” Dr. Mancera describes. “The wavelengths and frequency of the light can be adjusted to address many skin conditions, including rosacea, age spots, sun spots, hyperpigmentation, acne and acne scarring. IPL also works for hair and tattoo removal, so it’s a very versatile technology. 

“Next, we use a CO2 or YAG laser to resurface facial skin at a deeper level. Using the laser, we make pinpoint changes to the skin. These changes cause the skin to enter a healing phase when collagen, a building block of skin, regenerates. The production of new collagen revitalizes and fortifies the skin, creating a younger appearance.”

Double Trouble

Carlos Naguib, OD, is new to the team at Florida Eye Specialists & Cataract Institute. The optometrist grew up in Toronto after relocating from Cairo when he was 8. He crossed the border for his secondary education, earning a bachelor’s degree and Doctor of Optometry degree from Nova Southeastern University in Fort Lauderdale.

Carlos Naguib, OD

Carlos Naguib, OD

At Florida Eye Specialists & Cataract Institute, Dr. Naguib serves as a primary eye care practitioner.

“I take care of the entire eye in terms of primary eye diseases, such as glaucoma and macular degeneration,” he relates. “But I specialize in dry eye disease and dry eye therapies.

“Dry eye is a multifactorial disease. There are many reasons why someone might be affected by it. They could be aqueous deficient, meaning they have a lack of fluid production in their eyes, or they may have meibomian gland dysfunction, where the oil component of the tears is lacking.”

Every patient is different, so every patient’s dry eye treatment plan is tailored to address what that patient lacks.

“There is no cure for dry eye,” Dr. Naguib observes. “There are only different ways to manage it, and as we progress through the management plans, the treatment becomes more specialized. 

“We often start with preservative-free artificial tears, which are lubricant drops that most patients use day to day. We may insert punctal plugs into the drainage system of the eye to prevent tears from draining too quickly so the eyes stay lubricated. There are also medications that reduce inflammation in the eyes that causes dryness.”

Florida Eye Specialists & Cataract Institute also offers a new technology for treating dry eye called iLUX®, in which light-based heat is applied to the eyelids to soften trapped oils in the meibomian glands. Once cleared, the glands can smoothly release the oils necessary for an effective tear layer to lubricate the surface of the eyes.

Dry eye often occurs in combination with blepharitis, or inflammation of the eyelids. Often, debris accumulates on the eyelids, gets into the eye and causes irritation, redness and dryness. 

“Anything that disturbs the formation or quality of the tears can make dry eye symptoms worse,” Dr. Naguib contends. “We always treat the eyelids as well as the eyes when it comes to dry eye. We go back and forth between the two to make sure that the eyes stay healthy and lubricated.

“There are treatments for blepharitis that patients can do at home, including lid scrubs such as OCuSOFT®, SteriLid®and Avenova®. We can clean the eyelids in the office as well using the BlephEx®, a mechanical brush that goes straight through the lashes and knocks off all the debris that has accumulated on the lid. BlephEx treatment can change the patient’s symptoms almost instantly.” 

© FHCN article by Patti DiPanfilo. Photos by Jordan Pysz. mkb
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