Archive for the ‘Raymond Stein’ Category

Raymond Stein MD latest Testimonials

Monday, October 5th, 2015

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Dr Raymond Stein was invited to speak on the Catalys Precision Laser System at the American Society of Cataract & Refractive Surgery in San Francisco on April 18, 2013.

Wednesday, April 24th, 2013

Dr Stein presented his experience with the Catalys Precision Laser System to over 500 ophthalmologists from around the world at the Mascone convention centre in San Francisco. He spoke on the learning curve of introducing the technology and the safety profile. In reviewing all the technologies he has introduced at the Bochner Eye Institute over the past 20 years the Catalys laser had the easiest learning curve. In the first 40 cases treated, 32 were performed without ultrasound. By reducing or eliminating ultrasound energy there is less intraocular inflammation, and less chance of adversely affecting the corneal endothelium or leading to cystoid macular edema.

Dr Stein noted that Laser cataract surgery has significant clinical advantages especially in patients with Fuchs corneal dystrophy, shallow anterior chambers, dense nuclear cataracts, and weak zonules such as in pseudoexfoliation. In addition by performing an exact capsulotomy of 5 mm there is less chance that the implant will vault forward, be pushed posteriorly, or be tilted. This can result in an improved refractive outcome and quality of vision.

Another Satisfied Patient

Tuesday, January 22nd, 2013

 

Dr Raymond Stein’s patients share their appreciation

Friday, June 22nd, 2012

Dr Raymond Stein, Medical Director at the prestigious Bochner Eye Institute shares some of the feedback from his patients.

Dr Raymond Stein

Monday, June 18th, 2012

Dr Raymond Stein was invited to speak at the American Academy of Ophthalmology’s annual meeting in Orlando on October 21, 2011. His session was titled “Ask the Expert” and he spoke on the subject of Corneal Cross-Linking in Keratoconus.

Dr Raymond Stein was an invited guest speaker to the Vision Institute’s annual meeting in Toronto on November 4, 2011. The title of his presentation was “The Future of Cataract and Refractive Surgery”. Dr Stein discussed some of the new innovative treatments such as Laser Cataract Surgery, Corneal Inlays for presbyopia, Corneal cross-linking combined with topographic laser ablations, and Microwave technology for keratoconus. The audience was over
300 eye-care professionals.

Refractive Lens Exchange – FAQs by Dr Raymond Stein

Monday, May 14th, 2012

What is a Refractive Lens Exchange (RLE)?

RLE is an intraocular lens replacement procedure in which the normal crystalline lens of the eye is exchanged with an intraocular implant. The implant has a specific power so that nearsightedness, farsightedness, and/or astigmatism can be corrected. The main goal of RLE is to reduce dependency on glasses and contact lenses.

Which patients are good candidates for RLE?

Patients with refractive errors that are either too high for laser vision correction, are over the age of 40 and desire improvement in both distance and reading vision, or those with early crystalline lens changes.

How safe is RLE?

RLE is a very successful operation.  With a skilled surgeon using advanced technology patients usually have an excellent outcome.

Is the surgery painful?

No, in fact most patients are very comfortable during the procedure. There are no needles or sutures. The eye can be frozen with the simple application of anesthetic eye drops. Patients will notice a bright light from the microscope and a slight irritation but usually no discomfort.

Are there different types of RLE operations?

Yes, there are two main types of operations: Traditional RLE surgery and Laser RLE surgery. Traditional RLE surgery is performed with hand-held blades and other manual instruments. Laser RLE surgery is the most advanced technique and utilizes a sophisticated laser to automate most of the critical parts of the operation. This can lead to enhanced precision, accuracy, and safety. Both procedures, however, can give excellent outcomes.

Why does OHIP not cover RLE Surgery?

OHIP covers all medically necessary procedures. RLE surgery to reduce dependency on glasses or contact lenses is considered an elective procedure and not medically necessary.

Why do I require an implant at the time of RLE surgery?

After the lens is removed it is essential to have an implant, otherwise “coke-bottle” or extremely thick glasses are required in almost all patients. The lens normally helps to focus light on to the back of the eye for vision. An implant, with a specific power, will help to focus light and usually obviates the need for glasses or contact lenses.

How is the power of the implant determined?

The implant power can be determined by a variety of methods. The most accurate measurement is by the IOL Master, which uses a no-touch optical method to determine the length of the eye and the curvature of the front of the eye. Unlike with the older A scan method, no drops are required and nothing touches the eye. The information that is calculated is then inputted into a complex formula to determine the ideal power of the implant.

Are there different types of implants?

Yes, there are a number of different types of implants that can be used in RLE surgery. The main types of implants are aspheric, toric, and bifocal. An aspheric implant is a monofocal implant that is utilized when patients desire enhanced distance vision, and have low levels of astigmatism. A toric implant is the best choice in patients with higher degrees of astigmatism. The astigmatism correction of a toric implant is built directly into the implant and then the lens is rotated to a specific orientation in the eye. A bifocal implant is a multifocal implant that can provide both distance and near without glasses. There may be some glare and/or halos with this type of implant. These symptoms tend to diminish with time.

Are there any advantages to having RLE surgery at the Bochner Eye Institute versus a hospital?

The Bochner Eye Institute is one of the only independent eye surgical facilities outside of a hospital approved by the Ontario government. The surgeons are privileged to work with highly trained staff and utilize advanced RLE equipment. . There is no hospital in the Province that is able to offer the full range of elective choices. At the Bochner Eye Institute, Raymond Stein MD offers both Traditional RLE surgery and Laser RLE surgery.

Is it advised not to wear makeup on the day of my surgery?

Yes, it is best not to wear any makeup on the day of surgery. We do not want any granules to enter the ocular surface or into the eye.

What clothes should I wear for my surgery?

Wear casual comfortable clothes. Do not have a tight collar shirt or sweater.

Can I eat prior to my RLE operation?

Yes, you can have light breakfast on the day of your RLE procedure.

What is used to clean my lids on the day of surgery?

A disinfectant is used to clean and disinfect the lids and surface of the eye. The solution is called Betadine. It has a brown colour and is very effective in preventing infection.

Will my face be covered with a drape?

A paper drape is placed over your head and body. You will have lots of room for proper breathing. There is an opening over your treated eye that allows the surgeon good visibility for the procedure.

If I am claustrophobic what can be done at the time of surgery?

The paper drape can be lifted up to a greater degree over your face. The anesthetist can give you either oral or intravenous sedation. The cataract procedure is very quick. Even the most claustrophobic patients tend to do well.

Can the anesthetist put me to sleep?

It is not necessary for you to be put to sleep. The procedure is relatively easy and quick for patients. Most patients find RLE surgery easier than having simple dental work. If you really feel you need some sedation this can be administered by the anesthetist.

What will I feel, see, and or hear during my operation?

At the very beginning of the operation you will see a bright light, which is the microscope light. You will then feel a slight burning or irritation, which is the intraocular anesthetic. After approximately 30 to 60 seconds the microscope light will be less intense. You will feel some slight pulling during the operation but no pain. You will hear an automated voice from the ultrasound machine that will sometimes speak words and other times make some noises like a symphony. After 10 to 15 minutes the operation will be over. When you sit up everything will have a red hue and be somewhat dark. This is simply a reaction to the bright light. The vision will gradually improve over 30 minutes.

Can both eyes be treated on the same day?

It is preferred to have each eye treated on a different day separated by a few days. Dr Stein wants to make sure the first eye is healing well before performing surgery on the other eye.

Do I need someone to take me home after my surgery?

It is important to have someone take you home after the procedure. You are not permitted to drive home yourself. We certainly want to make sure that you get home safely. If you have had some sedation you may be slightly drowsy.

What will my vision be like after surgery?

When you go home the vision will be slightly blurred. The vision is typically better within 24 hours, although it sometimes takes a few days for any transient corneal swelling to resolve. The vision tends to gradually improve over a few weeks.

What medications should I use after my surgery?

You will be given a prescription for two medications, a combination antibiotic and steroid drop, and a nonsteroidal anti-inflammatory drop, both to be used for 3 weeks.

When can I drive after my surgery?

You must get the green light from either your surgeon or your referring eye-care professional. Typically by the next day, after you see the doctor, you may be able to drive. However, it may take a while to get used to your new vision. You need to exercise caution when driving until you are used to your new vision.

What are the most common complications?

The most common complication is transient corneal edema. The cornea can respond to the ultrasound (i.e. phacoemulsification) with some swelling that typically resolves in a few days. Patients may have some irritation or foreign body sensation during the first few weeks from the micro incisions. Artificial tears or lubricating drops are usually helpful.

What is the chance of infection?

Infection is an extremely rare complication and occurs in less than 1 in 10,000 cases. The scientific name is endophthalmitis, which means infection in the eye. All precautions are taken to reduce the incidence of infection at the time of surgery including the use of an antibiotic placed inside the eye at the conclusion of the operation. If an infection occurs, intensive antibiotic drops are used. Occasionally, additional surgery is required to place additional antibiotics in the eye.

What is cystoid macular edema?

Cystoid macular edema is swelling of the back of the eye on the retina. This occurs with an incidence of 1 in 500 cases. The macular edema can affect vision but is treatable with nonsteroidal and steroid drops. Treatment is almost always successful in restoring vision.

Do I need to wear a protective shield at bedtime after surgery?

A protective shield is usually worn for 5 nights after surgery. The shield will protect the eye by preventing pressure on the eye when you are sleeping or from inadvertent rubbing.

When can I eat and drink after my surgery?

You can eat and drink as you normally would immediately after the surgery.

Should I restrict my activities after surgery?

The next day you can take a shower and shampoo your hair but try not to get water in your eye. Do not lift over 20 pounds during the first week after your operation. You may go for a walk and lift light weights at any time. Do not go swimming for 2 weeks after your surgery because of the risk of infection. If you are active with Yoga you can return within a week but do not stand on your head for 3 weeks.

What can I do if I am having difficulty reading immediately after surgery?

If you are having difficulty reading you can purchase a simple pair of reading glasses from the drug store or dollar store. Although they may not be ideal they will help you out until a proper pair can be prescribed. The eye is usually fully healed at 3 to 4 weeks from the surgery and this is the time that a new prescription can be prescribed if needed.

Will I require glasses after surgery?

Patients that have an aspheric or toric implant will usually only need glasses for reading. Patients that select a bifocal implant will typically not need glasses unless the print is very small or the lighting is poor.

What can I do if I find my vision is not really sharp after RLE?

Laser vision correction can be performed to enhance your vision. Although 95% of patients have clear vision after RLE, in some cases a small residual prescription may be present. In this situation, laser vision correction can be performed to refine your vision. There is no charge for the procedure. It is important that the eye is fully healed from the RLE and therefore we recommend waiting at least 3 to 4 months before having laser vision correction.

What can I do if I am experiencing irritation in my eye after surgery?

You can purchase an artificial tear at the drug store from the over-the counter section. There are a variety of excellent brands such as Systane Ultra, Systane Balance, Refresh, Genteal, and Blink. You can use the tear drop when needed anywhere from once to 4-5 time

Click Here to Learn More about Dr Raymond Stein

Frequently asked questions – Cataract Surgery by Dr Ray Stein

Monday, May 14th, 2012

What is a cataract?

A cataract is an opacification or clouding of the lens of the eye. The normal lens is clear and allows light to pass through to the back of the eye. With age the lens becomes cloudy and interferes with vision. A change in glass prescription can usually be done at the early stage of a cataract. As the cataract becomes more mature there is no new glass prescription that will make a significant difference.

When is cataract surgery recommended?

Surgery is recommended when the diminished vision interferes with activities of daily living. These activities may include driving, especially at night, watching TV, using a computer, reading, playing sports, etc. At an advanced stage, cataracts can interfere with the ability to see steps, curbs, and other obstacles, which results in a greater chance of falls and fractures.

Does the cataract have to be “ripe” for surgery to be performed?

With advances in cataract surgery, it is no longer necessary for the cataract to be mature or “ripe”. An early cataract that interferes with the quality of vision can be corrected with surgery.

How safe is cataract surgery?

Cataract surgery is one of the most successful operations on the body. With a skilled surgeon using advanced technology patients usually have an excellent outcome.

Is the surgery painful?

No, in fact most patients are very comfortable during the procedure. There are no needles or sutures. The eye can be frozen with the simple application of anesthetic eye drops. Patients will notice a bright light from the microscope and a slight irritation but usually no discomfort.

Are there different types of cataract operations?

Yes, there are two main types of operations: traditional cataract surgery and laser cataract surgery. Traditional cataract surgery is performed with hand-held blades and other manual instruments. Laser cataract surgery is the most advanced technique and utilizes a sophisticated laser to automate most of the critical parts of the operation. This can lead to enhanced precision, accuracy, and safety. Both procedures, however, can give excellent outcomes.

Why does OHIP not cover Laser Cataract Surgery?

Laser cataract surgery represents new advanced technology but is not considered medically necessary. It is difficult for our health-care system to continue to pay for all innovations even if they offer an advancement in clinical outcomes.

Do I require an implant at the time of cataract surgery?

Yes, all patients have an implant of a specific power. After the cataract is removed it is essential to have an implant, otherwise “coke-bottle” or extremely thick glasses are required in almost all patients. The lens or cataract normally helps to focus light on to the back of the eye for vision. An implant will help to focus light and obviate the need for thick glasses.

How is the power of the implant determined?

The implant power can be determined by a variety of methods. The most accurate measurement is by the IOL Master, which uses no-touch optical methods to determine the length of the eye and the curvature of the front of the eye. Unlike with the older A scan method, no drops are required and nothing touches the eye. The information that is calculated is then inputted into a complex formula to determine the ideal power of the implant. In some situations, with a very advanced cataract, it is difficult to achieve an accurate calculation of the implant power.

Are there different types of implants?

Yes, there are a number of different types of implants. The main classifications of implants are standard, aspheric, toric, and bifocal. The standard implant is provided by the Ontario Health Insurance Program (OHIP). This is a monofocal implant that can provide satisfactory vision but usually requires the aid of glasses to fine tune sight. The other implants are not provided by OHIP but can be purchased by the patient. An aspheric implant can provide better quality of vision by reducing spherical aberration. This can reduce glare and usually provides better night vision. The aspheric implant is combined with an astigmatism reduction or control procedure to decrease the need for distance glasses by small incisions in the peripheral cornea. A toric implant, in addition to reducing spherical aberration and enhancing the quality of vision, can reduce astigmatism, and is the best choice in patients with higher degrees of astigmatism. The astigmatism correction of a toric implant is actually built directly into the implant and then rotated to a specific orientation in the eye. A bifocal implant is a multifocal implant that can provide both distance and near without glasses. There may be some glare and/or halos with this type of implant. These symptoms tend to diminish with time.

Why does OHIP only cover the cost of a standard implant?

OHIP covers all medically necessary implants and procedures. The premium lenses, such as the aspheric implant, toric implant, and bifocal implant are considered elective lenses to decrease the need for glasses. These implants are not considered medically necessary.

Are there any advantages to having cataract surgery at the Bochner Eye Institute versus a hospital?

The Bochner Eye Institute is one of the only independent eye surgical facilities outside of a hospital approved by the Ontario government. The surgeons are privileged to work with highly trained staff and utilize advanced cataract equipment. Patients can have surgery without cost or can elect to pay for advanced features such as premium implants, astigmatism control or reduction procedures, or laser cataract surgery. There is no hospital in the Province that is able to offer the full range of elective choices. Only traditional cataract surgery is performed in hospitals. At the Bochner Eye Institute both traditional cataract surgery and laser cataract surgery are offered said Raymond Stein

If I am on a blood thinner should I stop this medication prior to my surgery?

You should continue this medication as it is safer for your general health and the medication does not interfere with the success of the cataract operation. There is a greater chance of bruising on the surface of the eye but this disappears with time.

If I am on medication for prostate problems, should I stop this medication prior to surgery?

No, it is not necessary to stop this medication. Certain medications (eg Flomax) for benign prostatic hypertrophy can cause a permanent change to the iris that tend to make the iris floppy and the pupil small during cataract surgery. It is important to let the surgeon know if you are on this medication, or whether you have taken it in the past. There is no point in discontinuing the medication, as the iris changes tend to be irreversible. The surgeon can use a medication at the time of cataract surgery to make the iris less floppy. The results using this technique are generally excellent.

Is it advised not to wear makeup on the day of my surgery?

Yes, it is best not to wear any makeup on the day of surgery. We do not want any granules to enter the ocular surface or into the eye.

What clothes should I wear for my surgery?

Wear casual comfortable clothes. Do not have a tight collar shirt or sweater.

Can I eat prior to my cataract operation?

It is usually best not to eat after midnight on the day of your cataract operation. If your operation is in the afternoon you can have a light breakfast.

Should I take my own medications on the day of my surgery?

Please take your medications with a sip of water. The only exception is for diabetics who should refrain from taking their diabetic medications until after their surgery.

What is used to clean my lids on the day of surgery?

A disinfectant is used to clean and disinfect the lids and surface of the eye. The solution is called Betadine. It has a brown colour and is very effective in preventing infection.

Will my face be covered with a drape?

A paper drape is placed over your head and body. You will have lots of room for proper breathing. There is an opening over your treated eye that allows the surgeon good visibility for the procedure.

If I am claustrophobic what can be done at the time of surgery?

The paper drape can be lifted up to a greater degree over your face. The anesthetist can give you either oral or intravenous sedation. The cataract procedure is very quick. Even the most claustrophobic patients tend to do well.

Can the anesthetist put me to sleep?

It is not necessary for you to be put to sleep. The procedure is relatively easy and quick for patients. Most patients find cataract surgery easier than having simple dental work. If you really feel you need some sedation this can be administered by the anesthetist.

What will I feel, see, and or hear during my operation?

At the very beginning of the operation you will see a bright light, which is the microscope light. You will then feel a slight burning or irritation, which is the intraocular anesthetic. After approximately 30 to 60 seconds the microscope light will be less intense. You will feel some slight pulling during the operation but no pain. You will hear an automated voice from the ultrasound machine that will sometimes speak words and other times make some noises like a symphony. After 10 to 15 minutes the operation will be over. When you sit up everything will have a red hue and be somewhat dark. This is simply a reaction to the bright light. The vision will gradually improve over 30 minutes.

Do I need someone to take me home after my surgery?

It is important to have someone take you home after the procedure. You are not permitted to drive home yourself. We certainly want to make sure that you get home safely. If you have had some sedation you may be slightly drowsy.

What will my vision be like after surgery?

When you go home the vision will be slightly blurred. Although the vision is typically better within 24 hours it sometimes takes a few days for any transient corneal swelling to resolve. The vision tends to gradually improve over a few weeks.

What medications should I use after my surgery?

You will be given a prescription for a single medication, a combination of an antibiotic and steroid drop, to be used for 3 weeks. If you are at higher risk of developing macular edema, such as being a diabetic, you will also be given a nonsteroidal drop.

When can I drive after my surgery?

You must get the green light from either your surgeon or your referring eye-care professional. Typically by the next day after you see the surgeon you may be able to drive. However, it may take a while to get used to your new vision. Usually objects are brighter and clearer. You need to exercise caution when driving until you are used to your new vision.

What are the most common complications?

The most common complication is transient corneal edema. The cornea can respond to the ultrasound (ie phacoemulsification) with some swelling that typically resolves in a few days. Patients may have some irritation or foreign body sensation during the first few weeks from the micro incisions. Artificial tears or lubricating drops are usually helpful.

What is the chance of infection?

Infection is an extremely rare complication and occurs in less than 1 in 10,000 cases. The scientific name is endophthalmitis, which means infection in the eye. All precautions are taken to reduce the incidence of infection at the time of surgery including the use of an antibiotic placed inside the eye at the conclusion of the operation. If an infection occurs intensive antibiotic drops are used. Occasionally additional surgery is required to place additional antibiotics in the eye.

What is cystoid macular edema?

Cystoid macular edema is swelling of the back of the eye on the retina. This occurs with an incidence of 1 in 500 cases. The macular edema can affect vision but is treatable with nonsteroidal and steroid drops. Treatment is almost always successful in restoring vision.

Do I need to wear a protective shield at bedtime after surgery?

A protective shield is usually worn for 5 nights after surgery. The shield will protect the eye by preventing pressure on the eye when you are sleeping or from inadvertent rubbing.

When can I eat and drink after my surgery?

You can eat and drink as you normally would immediately after the surgery.

Should I restrict my activities after surgery?

The next day you can take a shower and shampoo your hair but try not to get water in your eye. Do not lift over 20 pounds during the first week after your operation. You may go for a walk and lift light weights at any time. Do not go swimming for 2 weeks after your surgery because of the risk of infection. If you are active with Yoga you can return within a week but do not stand on your head for 3 weeks.

What can I do if I am having difficulty reading immediately after surgery?

If you are having difficulty reading you can purchase a simple pair of reading glasses from the drug store or dollar store. Although they may not be ideal they will help you out until a proper pair can be prescribed. The eye is usually fully healed at 3 to 4 weeks from the surgery and this is the time that a new prescription can be prescribed.

Will I require glasses after surgery?

Patients that choose a standard implant will typically require glasses for both distance and near vision. Patients that choose an aspheric or toric implant will usually only need glasses for reading. Patients that select a bifocal implant typically do not need glasses unless the print is very small or the lighting is poor.

What can be done if I am having problems with my new glasses?

If you have had surgery on only one eye you may experience difficulty with new glasses. This may be due to the difference in the prescription between your two eyes, which results in different levels of magnification. Surgery for your other eye may be indicated, even in the presence of an early cataract, to help alleviate the difficulty with glasses.

What can I do if I am experiencing irritation in my eye after surgery?

You can purchase an artificial tear at the drug store from the over-the counter section. There are a variety of excellent brands such as Systane Ultra, Systane Balance, Refresh, Genteal, and Blink. You can use the tear drop when needed anywhere from once to 4-5 times per day. These drops are extremely safe.

Dr Raymond Stein other blog

Frequently asked questions – Implantable Contact Lens Procedure

Monday, May 14th, 2012

What is the Implantable Contact Lens (ICL) procedure?

The ICL is a very thin implant that is inserted through a microscopic opening in the cornea and positioned between the iris and the normal crystalline lens. The implant has a central thickness similar to a human hair, which is 50 microns.

 How do I know if I am a good candidate for the ICL procedure?

Patients that are not satisfactory candidates for laser vision correction are usually good candidates for the ICL. This usually means that the prescription is too high, and/or the corneas are too thin or are irregular. Usually whatever vision you have with glasses or soft contact lenses can be achieved postoperatively without optical aids. Patients should have a pupil size measured in dim light of 7 mm or smaller. There must be a satisfactory distance between the back surface of the cornea and the crystalline lens of 3.0 mm or greater. The eyes should be healthy inside without evidence of cataracts or significant macular degeneration.

What tests are performed to be sure that I qualify for the ICL?

A refraction is performed to determine your prescription and your vision. An instrument called the Colvard pupillometer is used to measure the pupil size in dim light. A Pentacam or Orbscan is performed to determine the distance from your cornea to your crystalline lens. An IOL Master is performed to determine the width of your cornea to assist in determining the length of the implant.

 Should I discontinue my contact lenses prior to the preoperative testing?

Yes, it is important to stop wearing soft contact lenses for approximately 5 days and rigid gas permeable lenses for at least 3 weeks prior to the preoperative testing. Contact lenses can potentially change the shape of the cornea and it is important that the corneas return to their normal shape prior to the preoperative testing.

Is the ICL customized for my eye?

Yes, the ICL is ordered directly from Switzerland where it is custom made for your eye. The lens has a specific prescription to correct nearsightedness, farsightedness, and/or astigmatism. In addition it is ordered with a specific length so that it fits well inside your eye.

 How long does it take to receive the ICL from the time it is ordered?

It takes approximately 6 weeks for the Bochner Eye Institute to receive the ICL from Switzerland after it has been ordered.

Why is a laser iridotomy necessary prior the ICL procedure?

A YAG iridotomy is a simple laser procedure to create a microscopic opening in the iris. This is important prior to the ICL procedure to prevent a buildup of eye pressure. Fluid normally flows inside the eye directly through the pupil. The ICL can potentially block fluid flow and create a high intraocular pressure.  A small opening in the iris is created which allows fluid to travel through the iris and prevent a buildup of pressure.

Are both eyes treated the same day?

Usually the eyes are treated on different days, a few days a part. Dr Stein wants to make sure the first eye in perfect before treating the second eye.

How does the ICL procedure differ from a refractive lens exchange?

There is no tissue removed with the ICL. With a refractive lens exchange the crystalline lens is removed using ultrasound and an artificial lens is inserted.

What are the advantages of the ICL over a refractive lens exchange?

By leaving your own crystalline lens in place you will retain your ability to see up close to a similar degree that you had prior to surgery with your glasses or contact lenses. With age the crystalline lens becomes harder and loses its ability to naturally change shape and help with focusing for near objects. This typically occurs between 42 and 46 years of age. By leaving your own crystalline lens in place you will retain your reading ability without glasses. If you are in your mid 40s then reading glasses will be required.

Is there anything I can do to avoid reading glasses?

Monovision can be performed in which one eye is treated to give the best distance vision and the other eye is treated to provide reading vision. Patients will often get used to their vision and function well. Sometimes driving at night may be more difficult and a simple pair of distance glasses can be prescribed so the reading eye is sharp for distance.

How is the ICL procedure performed?

The procedure is performed in the operating room. Your pupil will be dilated with dilating drops. Your eye will be frozen with anesthetic drops. Your lids and surface of the eye will be cleaned with a disinfectant solution. A paper drape will be placed over your body and head. There will be a small opening that exposes your eye. A speculum will be inserted to open your lids. A small incision will be made in the cornea. The ICL, which has been folded, is then inserted through a microscopic corneal incision into your eye. The ICL is then carefully positioned behind your iris and in front of the crystalline lens. Your pupil will then be constricted with drops. An antibiotic medication will then be instilled. You will then sit up and be escorted to the recovery area. After 30 to 45 minutes you will be taken to the first floor where Dr Stein will examine your eye and check your eye pressure. You will then be able to go home to rest. A follow-up appointment will be arranged for the next day.

Can I receive some sedation for the procedure?

Although most patients find the procedure relatively easy, an anesthetist will be present, and if you feel you would like some sedation this can be administered.

How quickly will my vision recover?

There is usually a rapid improvement in vision over 24 hours. Most patients have satisfactory vision for driving by the next day. It may take a few months for final healing to occur.

What are the potential complications of the ICL procedure?

Complications are uncommon with the ICL procedure. There is less than a 1% risk of developing a cataract or clouding of the lens. If this occurs the ICL can be removed, the cataract extracted, and a new implant inserted. The success rate is excellent at restoring vision. There is a theoretical risk of infection but no cases have been seen at the Bochner Eye Institute.

What can be done if I have a small prescription after my ICL procedure?

If you have a small prescription after the ICL then laser vision correction can be performed. Usually we wait a few months to be sure that your prescription is stable and your eye is fully healed.

Dr. Raymond Stein was one of four international surgeons interviewed by Review of Ophthalmology on the subject of Corneal Cross-linking (CXL)

Wednesday, March 21st, 2012

Dr Raymond Stein was one of four international surgeons interviewed by Review of Ophthalmology on the subject of Corneal Cross-linking (CXL).

The other surgeons interviewed were Dr Kanellopoulos (Greece), Dr Chayet (Mexico), and Dr Rubinfeld (United States). World-wide results have been very positive at preventing corneal ectasia. CXL is considered the standard of care around the globe for progressive keratoconus.

Learn More:

http://www.revophth.com/content/c/32329/

FAQS on Corneal Crosslinking by Dr Raymond Stein- Toronto Eye Surgeon

Friday, March 16th, 2012

Corneal Crosslinking – Frequently Asked Questions

Is Corneal Crosslinking (CXL) a new treatment for keratoconus?
CXL was introduced in Canada by the surgeons of the Bochner Eye Institute over 4 years ago. In Europe, where the procedure was pioneered, it has been performed for over 14 years ago. There are many long-term studies that demonstrate the efficacy and safety of the procedure.

What is the main goal of CXL?
The purpose of the treatment is to strengthen corneas so as to prevent progressive bulging and thinning that can interfere with vision. With a stronger and more stable cornea the risk of requiring a corneal transplant is practically eliminated.

What is the success rate of CXL?
At the Bochner Eye Institute over 3,000 eyes have been treated with CXL over the past 4 years. This is more than any other centre in the world. Patients have travelled from all over North America. The success rate at preventing progressive bulging and thinning has been over 98%.

Can CXL be repeated?
In rare cases (less than 2%) where CXL is not successful in stabilizing a cornea, a repeat treatment can be performed. There is no charge for this procedure at the Bochner Eye Institute.

Is there an ideal age for CXL?
Usually, the younger the patient the greater the chance of preserving vision with CXL. Patients treated at the Bochner Eye Institute have ranged in age from 10 to 60 years age. With treatment, the corneal contour is preserved, and therefore it is best to have CXL when the shape is only mildly distorted. Patients with advanced disease can have CXL but the vision may be less than ideal with glasses or soft contact lens necessitating the use of a rigid contact lens.

Are some keratoconus patients not good candidates for CXL?
Patients must have satisfactory corneal thickness for the procedure to be performed. A thickness of 400 microns is required prior to the ultraviolet light application. Corneas with a thickness between 320 microns and less than 400 microns can usually be treated by using specialized hypotonic drops to swell the cornea to 400 microns or greater prior to the ultraviolet light application. Also, corneas with significant central scarring that interferes with vision are not good candidates for CXL.

Can vision be improved with CXL?
Although the main goal of CXL is to stabilize the cornea, 60% of patients actually have an improvement in their vision. This is due to the fact that the corneal surface becomes less irregular with CXL as the steep areas are flattened and the flat areas are steepened.

How is the procedure performed?
The procedure is divided into 3 steps. Most patients find the procedure very easy and are comfortable. Anesthetic drops are instilled, which numbs the surface of the eye, and makes the procedure pain free. The first step of the procedure is the removal of the central corneal epithelium. A very gentle brush is used to polish away the soft cells of the front of the cornea referred to as the epithelium. The second part of the procedure is the instillation of specialized drops containing Riboflavin. Drops are typically used for 20 minutes. The third part of the procedure is the use of ultraviolet light, which is typically used for 10 minutes.

Why does the ultraviolet light treatment time vary from clinic to clinic?
The original treatment protocol in Europe was the use of ultraviolet light for 30 minutes at an energy level of 3mw/cm2. With the development of new CXL devices the energy level can be increased which shortens the treatment time said Dr Raymond Stein.

Can the corneal epithelium be left intact or does it have to be removed?
The long-term clinical studies have shown outstanding results when the epithelium is removed prior to CXL. New techniques are being developed to perform a transepithelial CXL approach in which the epithelium is left intact. It is essential for the success of this technique that the Riboflavin drops penetrate an intact epithelium to reach the deeper layers of the cornea in a high enough concentration. Early results with this technique are encouraging but we do not know the long-term results.

What is required after the treatment?
Immediately after the procedure a soft bandage contact lens is inserted which is worn for approximately 5 days. This allows enhanced comfort and promotes healing of the corneal epithelium. An antibiotic drop is used for 5 days and a steroid drop is used for 2 weeks. Artificial tears can be used as needed for comfort.

Is the vision better immediately after the procedure?
Usually the vision is slightly blurrier during the first month and then gradually improves. The blurred vision is related to the healing time of the corneal epithelium. Initially when the epithelium becomes intact it tends to be somewhat rough. With times it undergoes thickening and thinning in different areas to smooth the corneal contour.

How do I know if the treatment is successful?
Repeat corneal mapping is performed to demonstrate corneal stability or flattening. The mapping is typically performed at 4 to 6 months postoperatively and then annually. Sophisticated mapping techniques can evaluate both the front and back surfaces of the cornea to determine stability, improvement, or progression.

What are the potential complications of the treatment?
The complication rate is extremely low with CXL. The risk of infection is rare. In fact ultraviolet light can be used to kill bacteria and parasites in patients with corneal infections. Occasionally there is a delay in the healing of the corneal epithelium, which can delay the return of best vision.

When can I start wearing contact lenses?
After the procedure it is best to wait 2 weeks before returning to contact lens wear. If you have never worn contact lenses and would like to start lens wear it is best to wait at least one month before a consistent refraction can be obtained and lenses fitted.

How can I improve my vision so that I do not need rigid contact lenses?
There are two surgical options to reduce the irregular astigmatism so that you can see better without rigid contact lenses. An intracorneal ring (Intacs) can be performed in which one or two rings are inserted into the cornea to flatten steep areas. The other option is a topographically-linked photorefractive keratectomy (PRK) in which an excimer laser is used to flatten the steep cornea and steepen the flat cornea to enhance vision. Both these procedures can be performed at the same time as CXL or at later date.

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