Amazing Feedback on Patient’s Experience at Bochner Eye Institute

July 28th, 2015

Greetings, Dr. Ray!

A week after your two surgeries, one of your strongest protagonists, Paul Monk,  declared my vision in both eyes to be 20/20. I endured no pain, nor even discomfort through this procedure, and have been able to discard my strong prescription specs and contact lenses, worn for 70 years! What is a daily routine for you is a major life changing event for your patients. You must be most proud and pleased with the profound significance that the exceptional results of your personal efforts and those of your superb organization have on all of those who have been privileged to be in your care!

As a business veteran, I find myself critiquing all aspects of the businesses that I deal with; it is almost a hobby, or is it an obsession?!
Every aspect of the Bochner Eye Institute is absolutely first class, and so confidence inspiring. Your marketing is superb! Your process, and your team, from the minute one walks in your door for the first time until completion of the “program” is efficient and welcoming and so friendly. Your facilities are most comfortable, homey and relaxing. And the results for your patients are downright exciting!

I am so pleased that Paul Monk discovered my problem and sent me to The Bochner Eye Institute.

My sincere best wishes for continued great success!

John

Bochner Eye Institute Provides Eyecare at Pan Am and Parapan Am Games

July 27th, 2015

Raymond SteinDr Raymond Stein and the Bochner Eye Institute were selected to provide eyecare services to the atheletes at the Pan Am (July 10 to 26) and Parapan Am Games (Aug 7 to 15) in Toronto. “We were delighted with this opportunity to look after the urgent and emergency care of atheletes from over 40 countries’ said Dr Raymond Stein. “We had over 80 volunteer optometrists and ophthalmlogists that provided timely care in the Bochner Eye Clinic that was established at the Pan Am Village”.

 

 

 

 

 

Feedback from a happy patient

February 2nd, 2015
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Read what our patients are saying

February 2nd, 2015
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Multifocal Implant Cataract or Refractive Lens Exchange with the Mplus Implant

October 17th, 2014

After over 250,000 procedures with the Mplus implant in Europe, we introduced this technology in Canada 3 years ago.
•    The implant is a segmented bifocal with minimal loss of light.
•    Unlike other multifocal implants patients typically have satisfactory reading, intermediate, and distance vision.
•    The Mplus is not pupillary dependent and as such reading can be very good even in dim light.
•    Patients can have some glare and/or halos at night but typically this is mild and improves with time.
•    The best candidates are those in which their line-of sight is less than 0.4 mm of the centre of the pupil. We are currently measuring this factor with the Acutarget machine.

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Difficulty Reading? Raindrop Corneal Inlay

October 17th, 2014

The Raindrop Corneal Inlay is the newest inlay and was performed first in Canada at the Bochner Eye Institute 5 months ago. The inlay is currently available only through special access through Health Canada.
•    The inlay is transparent, only 2 mm in size, and placed beneath a corneal flap.
•    The Raindrop increases central steepening to enhance reading.
•    Unlike other inlays it can provide satisfactory reading vision even in dim light.
•    Follow-up on our initial patients have been very encouraging with a high patient satisfaction and quick return of both distance and near vision.

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Laser Cataract Surgery- The First Centre in Canada to use the Catalys Precision Laser

October 17th, 2014

After performing over 800 laser cataract procedures with the Catalys system here are our results and/or impressions:
•    Perfectly round capsulotomy in 100% of eyes
•    Elimination of phacoemulsification in 85% of cases
•    Reduction of phacoemulsification in all hard lenses
•    No cases of ruptured posterior capsules
•    Less corneal edema, especially in those with corneal guttata
•    Less intraocular tilting because of a perfectly round capsulotomy
•    High patient satisfaction

Read our Article on Femtosecond Cataract Surgery

Topography-PRK & CXL Enhancing BCSVA

October 17th, 2014

Topography-PRK (TG-PRK) combined with CXL continues to evolve in the treatment of keratoconus, pellucid marginal degeneration, and ectasia. Here are a few important points to understand:
•    The excimer laser guided by topography can flatten steep areas and steepen flat areas of the cornea to decrease irregular astigmatism. By reducing irregularity of the corneal surface, BCSVA can be improved.
•    Results are better if TG-PRK is combined with CXL rather than performing CXL initially and TG-PRK at a later date.
•    The best candidates are those with clear corneas, a thickness of over 450 microns, and a dioptric difference across the cornea of less than 10 diopters.
•    The main goal is to improve BCSVA and not necessarily UCVA. Glasses and or contact lenses are still typically required postoperatively.
•    98% of cases have shown success in stabilizing the corneal curvature and preventing the need for a corneal transplant.

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Top Choice Awards is honoured to announce that Bochner Eye Institute has been voted Top Laser Vision Correction Services of 2014 in City of Toronto

October 17th, 2014

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Lessons Learned in Treatment of Keratoconus by Raymond Stein MD

April 8th, 2014

Experience with CXL, Topography-linked PRK, Intacs, & Phakic IOLs

Over the past years 6 years, we have performed over 4,000 CXL procedures and/or CXL combined with a topographically-linked PRK. In addition, in selected keratoconus patients, we have inserted either intracorneal rings or toric phakic IOLs. Here are our top 10 lessons learned in the surgical management of keratoconus.
1.    CXL is successful in halting keratoconus progression in 98% of eyes. Success rate is higher for corneas that are clear and are less than 60
2.    CXL should be performed on patients as young as possible to halt disease progression and loss of best-corrected spectacle acuity. We have treated patients as young as 10 years of age with corneal stability over a followup period of up to 6 years.

3.    Bilateral CXL should be performed in patients under 25 years of age with unilateral disease. Theoretically the “normal” eye can be followed for signs of disease progression, but unfortunately in some cases the disease can progress rapidly with a loss of best-corrected spectacle acuity. Since keratoconus occurs bilaterally in over 90% of patients we feel it is clinically prudent to perform bilateral CXL in younger patients.

4.    Specialized Riboflavin solutions can induce corneal swelling by at least 100 microns. Preoperatively this means that a 350 micron cornea prior to epithelial removal can usually be treated by CXL. The only corneas that cannot be swollen to any significant extent are those with corneal scars.

5.    The combination of a topographically-linked PRK (TG-PRK) with CXL offers the best chance of improving best-corrected spectacle visual acuity. TG-PRK utilizes preoperative topography maps to guide the excimer laser to flatten steep areas and steepen flat areas. This can result in a decrease in irregular astigmatism and improvement in best-corrected spectacle acuity. Thicker corneas allow for treatment using larger optical zones which have a greater effect. In addition, corneas with less than 10 diopters of difference in the central pupillary area tend to have a greater reduction in irregular astigmatism.

Postop—————————- Preop—————————- Difference Map

In the case above, note the preop inferior to superior difference of around 10 D. This allowed for successful treatment of the irregular astigmatism by flattening the inferior cornea by 4.8 D and steepening the superior cornea by 4.7 D. 

6.    Diagnosis of keratoconus should be made using elevation topography (eg Pentacam), and a careful slitlamp exam. Elevation topography evaluates both anterior and posterior corneal elevation and produces a pachymetry map. Pseudokeratoconus can occasionally be seen using only computerized topography. It is not uncommon for the following conditions to create a pseuokeratoconus pattern: epithelial basement membrane dystrophy (see images below), superficial punctate keratopathy, amiodarone keratopathy, focal corneal scars, and Salzman’s nodular degeneration.

7.    TG-PRK is a more customized approach than intracorneal rings. Usually one or two rings are inserted in the midperiphery. We reserve corneal rings for thin central corneas in which TG-PRK cannot be performed. Rings are typically inserted in advanced cases to allow enhanced contact lens wear.

8.    Best-corrected spectacle acuity can take 6 months to be achieved after CXL or CXL with TG-PRK. It takes time for epithelial maturation to occur. The epithelium can undergo hyperplasia and/or hypoplasia to smooth the corneal surface.

9.    Patients at any age with stable keratoconus may benefit from CXL and TG-PRK to improve best-corrected spectacle acuity. By reducing irregular astigmatism, patients may achieve satisfactory vision with glasses or soft contact lenses.

10.    Stable keratoconus patients with minimal irregular astigmatism, that desire an improvement in uncorrected visual acuity may benefit from a toric implantable contact lens. However, if the refractive error is low then PRK can be performed with limited CXL. This CXL procedure is associated with minimal corneal flattening which results in a more predictable refractive outcome.
Summary

I hope you find these clinical observations of interest in the management of keratoconus. If you have any questions or comments please feel free to contact me at info@Bochner.com.

Sincerely,

Raymond Stein, MD, FRCSC
Medical Director, Bochner Eye Institute
Associate Professor of Ophthalmology, University of Toronto