On to the News.

CXL (cornea collegen crosslinking) studies for ectiasia and Keratoconus

Bill Trattler, M.D and Eric Donnenfeld related their findings of their studies, overall there is great success in halting corneal thinning, there is even some regression. The indications seem to point to early intervention rather than treating advanced cases.  The american studies lean toward epithelium on techniques rather than epithelium off techniques used in Europe.  What is all this in english..and why is it important?  This procedure consists of exposing the front of the eye (the Cornea) to an ultavioloet light source for approximately 30 minutes. The cornea is treated with Riboflavin (one of the B vitamins). The collagen in the cornea becomes crosslinked (forms bridges between individual collagen strands) making the cornea stiffer resisting forward bowing.  The treatment can be done in the doctors office.  The FDA has not approved this treatment in the US yet.  There are several centers involved in studies.

Who is this treatment for:

• Patients with Keratoconus ( a genetic disease of the cornea causing it to thin and bow forward causing progressive nearsightedness).
• Patients who have had LASIK of PRK and have ectasia (a condition that causing thinning and progressive nearsightedness)

Laser Cataract Surgery

Richard Mckool, Eric Donnenfeld, Dick Lindstrom, Bill Trattler and Ugday Devgan all gave us their take on The New LenSX and LensAR Laser cataract units that are now FDA approved. Optimedica is not far behind and will introduce a unit soon.   They all think these units will allow great improvements in cataract surgery while decreasing patient risk.  The surgeon still has to enter the eye to remove the lens fragments and to insert a new prosthetic lens (IOL).  The units are very expensive to purchase and have a per use fee, This will increase the cost of surgery to the patient.  Most of us doing premium lens surgery will use these lasers in the near future, charging the patient one fee for Refractive Cataract surgery with a premium lens and Laser incisions with Laser assisted cataract removal (LACR).  See the Videos below. Exciting times to be an Ophthalmologist!

Intraocular Lenses

Just a brief  note Alcon quietly introduced a preloaded version of  Its IQ Acrysof lens in a C cartridge along with the other lenses I mentioned in the previous post. These are useful in places where staff is unavailable or unable to load the  lens, decreases chance of contamination or lens damage.  Previously only a B cartridge pre loaded was available, this was unsuitable for small incision surgery.

Lasik guidelines for thin corneas

LASIK in thin corneas with normal topographies Posted by William B. Trattler, MD   September 23, 2010 03:37 PM Having returned from the European Society of Cataract and Refractive Surgeons’ annual meeting in Paris, I feel fortunate to have had the opportunity to see firsthand how many European surgeons approach patients in both cataract and refractive surgery, as they have technologies ranging from topography-guided PRK, toric multifocal implants, toric phakic IOLs and many other interesting devices. Besides interesting technologies, I also had the chance to learn how Europeans approach various controversial topics in refractive surgery. Of particular interest to me was the discussion on LASIK in thin corneas. Although some doctors may suggest that any cornea that is not within two standard deviations of the average corneal thickness is “abnormal,” the scientific data strongly support the fact that there is no direct relationship between corneal thickness and corneal strength when corneal topography is normal. And, in fact, we have learned from cross-linking that the same cornea after cross-linking is thinner but significantly stronger. Obviously, the real question is how do eyes with thin corneas and normal topographies fair with LASIK? At the ISRS symposium at ESCRS, Dr. Steven Schallhorn shared the latest data from Optical Express, which has numerous LASIK centers distributed throughout Europe. Dr. Schallhorn shared the results of a series of more than 80,000 eyes that have undergone LASIK, including more than 2,000 eyes with corneas thinner than 500 µm and normal topographies. Dr. Schallhorn noted that the early results reveal that no eyes with thin corneas had developed ectasia, while three cases of ectasia developed in eyes of patients with corneal thickness above 500 µm. When taken in the context of the six peer-reviewed articles in the medical literature that looked at the results of LASIK in thin corneas with normal topography, it is my strong belief that corneal thickness as an isolated parameter has no bearing on the risk of ectasia after LASIK. Obviously, it is natural for surgeons to work very hard to ensure that topographies of patients with thin corneas do not have any signs suggestive of early keratoconus. As well, it should be noted that some of the European doctors I spoke with still prefer PRK for corneas thinner than 500 µm — but noted that this was not based on any concrete evidence.

If you are wanting better reading vision the Alcon Acrysof Restor lens has to be a great choice for your Cataract or Clear lens replacement surgery; soon the astigmatism correcting feature of the Acrysof  toric Intraocular lenses will be combined with this lens for patients with astigmatism!  Alcon just announced these lenses outside the USA, after FDA approval they will be available here. Learn more here http://www.restortoric.com/.

On the Focusing lens front (We call these Accommodating Intraocular lenses): Lenstec’s Tetraflex is an intraocular lens implant (IOL) that is used for cataract surgery.   The Tetraflex IOL accomodates to give a range of vision.  The Tetraflex is not yet FDA approved in the United States, but is currently in use in Europe.  Lenstec will also introduce Tetraflex HD after FDA approval.  Lenstec’s Softec HD is a precision monofocal lens that is already FDA approved for single focus lens replacement.  The expected advantage of the Tetraflex and Tetraflex HD over the Softec HD is a wider range of sharp vision without glasses or contact lenses for distance, computer, and reading activities.  The lens works by flexing within the eye when patients attempt to read. Dr Titone uses the SoftecHD lens by Lenstec its clarity of vision reported by patients is impressive, we are looking forward in offering the TetraflexHD to our patients when it becomes FDA approved.

Tetraflex reviews have been favorable by surgeons and patients.  Tetraflex lens in the news  Click this link to an article by a U.S. surgeon who has implanted Tetraflex as part of the FDA trials.

See the TV news story about patient who had Tetraflex IOL in Miami during U.S. FDA trials.

The Acysof Toric, Acrysof Restor and Tetraflex costs are usually partially covered under medical insurance, there are added out-of-pocket costs compared to standard lenses. If you are seeking the best vision you can have after cataract or clear lens surgery you should consider one of the Advanced Technology lenses, speak to Dr Titone about your options or ask questions on the blog.

My father wanted a website that could accomplish a few main goals. He wanted a website that serves as a destination for future patients to gather information on a variety of procedures he specializes in. The second goal was to provide a hub for all of East Carolina Center for Sight’s social media. This website will now house the very blog you are reading, as a place for Dr. Titone to update the community about the latest and greatest news in the opthalmology world. Eccsight.com serves as the main hub for ECC’s Facebook, Twitter and other social media networks.

The last thing my father wanted to accomplish with the new Eccsight.com was to increase transparency between the doctor patient relationship. He wanted all future and current patients to be able to find more information about him and his staff. He also wanted to increase two way communication via our contact form and various social media networks.

So take a look around, and let us know what you think! Leave us a comment on this post or via the contact form in the main menu. We all sincerely hope our new website helps us serve the community in the best possible way.