Picture Perfect

Advanced technology leads to successful treatment of vision, eye disorders.

Much like a camera, the eye uses a lens to focus on images. When a camera’s lens becomes cloudy, it cannot take clear pictures. The same is true of the eye, which can naturally become cloudy as people age. This natural clouding of the eye’s lens, known as a cataract, affects more than half of Americans by age 80.

Photo by Michelle Brooks.

Dilip “Dr. Samy” Rathinasamy, MD and Ana-Maria Oliva, MD

The only way to treat cataracts is by surgically removing the affected natural lens and replacing it with a clear, synthetic intraocular lens, or IOL. To achieve the best possible outcomes for their patients, the cataract surgeons at Florida Eye Specialists & Cataract Institute employ the most advanced surgical technologies.

An example is the LENSAR® Laser System. LENSAR is on the leading edge of femtosecond laser technology. Its added functions and precise laser incisions enable surgeons to remove cataracts with increased safety and position IOLs with greater accuracy. These innovations lead to better vision following surgery.

“I have performed thousands of cataract surgeries during my career, and I must say, the LENSAR technology is one of the most exciting innovations I’ve seen,” asserts Gregory L. Henderson, MD, who founded Florida Eye Specialists & Cataracts Institute in 1981.

Photo by Fred Bellet.

Gregory L. Henderson, MD

“The LENSAR Laser System replaces the blades and instrumentation of the past with an advanced femtosecond laser. Even the most experienced surgeon’s hand cannot match the precision and gentle touch of the LENSAR system.”

The LENSAR automates certain aspects of cataract surgery that were traditionally done by hand. The surgery is more efficient, more effective and safer.

“The laser makes the initial incision into the eye,” Dilip “Dr. Samy” Rathinasamy, MD, says. “It can also create the capsulotomy, which is an opening into the thin, fragile membrane that holds the cataract. And it does so with exceptional precision.

“A capsulotomy done by hand can be less than perfect. The importance of having a perfect capsulotomy is that the replacement lens can then sit in a more optimal position, which ultimately gives the patient better vision.”

Three in One

Another example of advanced technology used by the cataract surgeons at Florida Eye Specialists & Cataract Institute is the PanOptix® trifocal lens by Alcon.

“The PanOptix trifocal intraocular lens became available in the United States in late 2019, and it is the only trifocal lens approved for use in the US,” Priya M. Mathews, MD, describes. “It has quickly become a popular lens choice because it virtually eliminates the need for glasses following cataract surgery.

Photo by Jordan Pysz.

Priya M. Mathews, MD

“People today have more active lifestyles and use their computers and smartphones with greater frequency. They want to be able to see at all distances following cataract surgery, and they do not want the hassle of glasses.”

“The PanOptix trifocal lens gives people that luxury because it gives them near, intermediate and distance vision, eliminating the need for spectacles,” Dr. Samy adds. “The PanOptix uses different locations on the lens, called the optic, to enable clear vision at these three different focal points.”

Nontraditional Transplant

The eye’s cornea is made up of five layers, and during a traditional cornea transplant, the entire cornea is removed and replaced with donor tissue. With the newer surgical techniques performed at Florida Eye Specialists & Cataract Institute, surgeons can select the diseased layer of the cornea and replace only that layer.

“One technique is called DMEK, which is an acronym for Descemet membrane endothelial keratoplasty,” Dr. Mathews explains. “During DMEK, the surgeon removes and replaces a very thin layer of the cornea. In this case, it is two layers, the Descemet membrane, the basement membrane that lies deep in the cornea, and the endothelium.

“Techniques such as DMEK, which transplant only a portion of the cornea, provide patients with much better vision than can be achieved by replacing the entire cornea. And because the patient is keeping most of their own cornea and only receiving a small piece of donor tissue, there is less chance for rejection.”

Dr. Mathews also performs keratoprosthesis surgery, which is the replacement of the entire cornea with an artificial cornea. This may be an option for patients who are not suitable candidates for fresh
tissue transplant.

Seeing Is Believing

The eyes are one of the first things people notice when meeting someone and can say a lot about that person.

“When we first meet someone and initially make eye contact with them, we immediately begin to form our first impression of that person,” asserts Craig E. Munger, MD, PhD, an oculoplastic surgeon. “We judge that person to be tired, sad, angry or pleasant based on the appearance of the area around their eyes.”

Photo by Jordan Pysz.

Craig E. Munger, MD, PhD

Puffy or drooping eyelids can make people look old, tired or even mean. When their patients have sagging eyelids, Dr. Munger and colleague Robert J. Applebaum, MD, often recommend blepharoplasty, a safe, effective and cosmetically appealing procedure also known as eyelid surgery.

Blepharoplasty is a surgical procedure that involves removing excess eyelid tissue. It can be done on the upper and lower eyelids, and can make a dramatic difference in the appearance of the face.

“With upper blepharoplasty, excess skin is removed from the upper eyelids, which can drop due to muscle weakness,” Dr. Applebaum describes. “The repairs we perform help functionally because the excess tissue can get in the way of vision and endanger the patient. It can also cause headaches and other problems.

“I also perform blepharoplasties for cosmetic purposes, when people are unhappy with the appearance of their lids. These surgeries can significantly improve the look of their eyes.” The lower lids can project a poor first impression as well.

“Most of us are born with five bags of fat around the eye to protect it and hold it in the socket,” Dr. Munger notes. “With aging, however, that fat can come forward and manifest itself as puffiness under the eye. Lower blepharoplasty can diminish the look of tiredness and aging by decreasing excess fat and skin beneath the eyes.”

Dr. Applebaum and Dr. Munger also offer a variety of nonsurgical facial cosmetic services. These include BOTOX® Cosmetic injections, a variety of facial fillers and intense pulsed light, or IPL. These options can help reverse the changes associated with aging.

Photo by Jordan Pysz.

Dr. Applebaum evaluates a patient at Florida Eye Specialists & Cataract Institute.

Lashing Out

A common condition treated at Florida Eye Specialists & Cataract Institute is blepharitis, an infection of the eyelids and eyelashes. Blepharitis commonly occurs simultaneously with dry eye. If left untreated, these conditions can lead to permanent eyelid and tear gland dysfunction as well as corneal damage.

“Blepharitis is most commonly caused by an overgrowth of bacteria that live along the margins of the eyelids and at the base of the lashes,” L. Ray Alonzo, OD, reports. “Not only do these bacteria cause the symptoms of blepharitis, they also produce the substances that inflame the oil glands in the eyes, causing dry eyes.

“Blepharitis should be taken seriously because of its link to dry eyes and because it can lead to complications. These include lashes falling out, lashes growing in the wrong direction because the base of the lash gets scarred, and lashes growing inward toward the eye and damaging the cornea.”

Photo by Jordan Pysz.

L. Ray Alonzo, OD

The complications associated with blepharitis and dry eye can be treated and possibly prevented if eyelid hygiene is properly undertaken. For years, hygiene options included cleaning the lids with diluted baby shampoo or eye scrub pads. Now, there’s also the BlephEx®. The BlephEx is a handheld machine with a medical-grade micro sponge that gently spins to scrub and massage the eyelid margins, cleaning and exfoliating the eyelids and lashes, and relieving symptoms.

“The BlephEx removes all the debris around the base of the eyelashes and helps keep the lids cleaner,” Pauline Thai, OD, confirms. “That takes away the food for the bacteria causing the redness and inflammation around the eyelids that occur with blepharitis and dry eye.

“We do a one-minute cleaning of the lid margins in one direction, then press a button and the machine spins in the opposite direction. We go back over the lids, and the sponge removes everything that was loosened on the first pass. I’ve seen really great improvement in blepharitis and dry eye using the BlephEx.”

Pressure Cooker

Glaucoma, the second leading cause of blindness in the country, is the degeneration of optic nerve fibers that are sending signals to the brain, enabling vision to occur. Glaucoma has been associated with abnormal eye pressure due to elevated intraocular fluid pressure (IOP). This increased pressure damages the optic nerve fibers.

“Glaucoma can occur at any age,” William A. Reeves, MD, observes, “but the risk increases with age. Unlike cataracts, the vision loss from glaucoma cannot usually be restored. Consequently, early detection and management of this disease is important to try to prevent progression of vision loss.”

Many people are affected by glaucoma, and some are unaware the condition is there.

Photo by Jordan Pysz.

Ignatius C. Cyriac, MD

“It is estimated that about 4 million people have glaucoma, half of whom don’t even know they have it,” Ignatius C. Cyriac, MD, asserts. “That is why early detection is so important.

“There is not a cure for glaucoma yet, which is another reason early detection is so critical. Once we diagnose glaucoma, we can control it, and the earlier we catch it, the easier it is to control.”

“When we diagnose glaucoma early, patients may never have a problem with their vision,” Dr. Reeves says. “What we are trying to do is prevent them from ever developing one, so our treatments are really geared toward reducing pressure within the eye. This reduction in pressure has proven to slow down or halt the progression of glaucoma.”

“The latest in the treatment of glaucoma is microinvasive glaucoma surgery, or MIGS,” Ana-Maria Oliva, MD, points out. “That is a procedure we are actually able to perform during cataract surgery. Twenty percent of the population that has cataract surgery also has mild to moderate glaucoma.”

MIGS is done while the patient is already in the operating suite and prepped for surgery. It is performed immediately following the cataract surgery, after the replacement lens is implanted, and takes less than five minutes to complete.

“A new device used during MIGS is called the iStent inject®,” Dr. Oliva describes. “The iStent inject is used in adults with mild to moderate open-angle glaucoma as well as cataract patients currently using glaucoma medication. The iStent inject creates new pathways in the drainage system for better fluid flow out of the eye.”

Retinal Restraints

The two most common disorders of the retina are diabetic retinopathy and macular degeneration, two leading causes of blindness in adults. Marguerite Kohlhepp, MD, has expertise in
treating retinal diseases.

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

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

Macular degeneration is another serious threat to sight that can occur as people age. It is a disease in which the main images in vision become less discernible.

“Think of the retina as being 10 layers thick with many blood vessels nourishing it,” Dan P. Montzka, MD, elaborates. “Macular degeneration is a disease in which some of those layers essentially become diseased and waste away. As a consequence, some of the blood vessels pop and leak.

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

Diabetic retinopathy and macular degeneration are examples of medical retinal disorders.

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

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

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

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

Kid Stuff

FHCN file photo.

Ronni Chen, MD

Ronni Chen, MD, a pediatric ophthalmologist, sees patients at the Brandon clinic on a part-time basis. She treats all the eye conditions that are commonplace during childhood and adolescence. Often, her patients are children who have failed screening exams by their physicians or schools.

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

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

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