Archive for the ‘Bochner Eye Institute’ Category

Bochner Establishes a Complimentary Keratoconus Clinic

Thursday, August 24th, 2017

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Patients with keratoconus or suspected keratoconus require corneal imaging to show anterior curvature, anterior elevation, posterior elevation, and pachymetry. Sophisticated corneal tomography and topography imaging allows for an early diagnosis of keratoconus and follow-up examinations can document stability or progressive disease.

At Bochner, our Keratoconus Clinic allows us to devise and review with patients and referring doctors a detailed treatment plan. Treatment options depend on a patient’s age, level of best-corrected spectacle acuity and uncorrected acuity, dioptric difference across a cornea, pachymetry, corneal curvature, and/or the presence of any significant corneal scarring. We have developed a decision tree that guides our recommendations on the following clinical options:

  1. Corneal crosslinking to stabilize a cornea.
  2. Corneal crosslinking + Topography-guided PRK to stabilize a cornea and improve best-corrected spectacle acuity by reducing irregular astigmatism.
  3. Corneal crosslinking + Intracorneal rings to allow enhanced contact lens wear in corneas too thin for Topography-guided PRK.
  4. Toric implantable contact lens to enhance uncorrected acuity.
  5. PRK and limited corneal crosslinking to improve uncorrected acuity.
  6. RGP, hybrid, or scleral lenses to improve best-corrected acuity.

Laser Cataract Surgery

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Since acquiring the first Catalys femtosecond laser in Canada 5 years ago the percentage of patients choosing this advanced technology has continued to increase. One-hundred percent of the 34 Ophthalmologists and optometrists that have undergone cataract surgery at Bochner since 2012 have opted for laser surgery versus traditional surgery.

Our top 4 advantages of Laser Cataract Surgery versus Traditional Surgery are as follows:
Reduction or Elimination of Phacoemulsification Energy Traditional phacoemulsification utilizes a probe that vibrates 20,000 times per minute to break up a cataract. This is similar to a jack hammer breaking up cement. In the eye this energy can cause intraocular inflammation and loss of corneal endothelial cells. With the Catalys laser 85% of our cataract cases are now accomplished without any phacoemulsification. In the remaining 15% of cases, the energy from phacoemulsification is greatly reduced. Elimination or reduction of phacoemulsification is possible because of the unique laser fragmentation of the Catalys laser that softens a wide area of the lens.
• Accurate and Consistent Capsulorehexis A 5 mm capsulorehexis performed with the Catalys laser is accomplished in 1.6 seconds. This quick speed is important to decrease the chance of any radial tears that could lead to rupture of the posterior capsule and loss of the nucleus into the vitreous. In over 2,700 eyes treated at Bochner, we have only seen one radial tear.
• Capsulorehexis Centred Over the Visual Axis The Catalys identifies the visual axis and can create a perfectly round capsulorehexis centered over this point. The surgeon then aligns the centre of the implant over the visual axis, which allows for a small amount of anterior capsule covering the implant. Centration of an implant on the visual axis can decrease the induction of higher order aberrations with aspheric and toric implants and improves patient satisfaction with multifocal implants.
• Laser Astigmatism Reduction Astigmatism reduction with laser arcuate cuts has been shown to be more predictable than with a hand held blade. The laser can produce cuts at an exact depth, angle, length, and location. Laser arcuate incisions can be opened by the surgeon at the time of surgery or if combined with a toric implant the incisions can be opened if necessary postoperatively to fine tune the outcome.
Read article by Dr Gifford-Jones in Toronto Sun (July 2017): When You Need Cataract Surgery – Dr Gifford-Jones


 

Keratoconus & Cataract Clinics
- Contact Information -
Our Toronto, Scarborough, and Unionville Offices now offer Keratoconus and Cataract Clinics, in addition to consultations for Laser Vision Correction, Refractive Lens Exchange, and other refractive procedures. Referrals can be mailed, faxed or emailed. Our Oakville Office is limited at this time to general medical ophthalmology referrals.

Toronto
40 Prince Arthur Avenue, Toronto, Ontario M5R 1A9
Phone 416 960 2020
Fax 416 966 8917
Bochner@bochner.com

Scarborough
2941 Lawrence Ave East, Scarborough, ON M1P 2V6
Phone 416 431 7449
Fax 416 439 9523
Scarborough@bochner.com

Unionville
147 Main Street, Unionville, ON L3R 2G8
Phone 905 470 2020
Fax 905 470 2216
Unionville@bochner.com

Oakville
353 Iroquois Shore Road, Oakville, ON L6H 1M3
Phone 905 815 1112
Fax 905 845 7828
Oakville@bochner.com

Bochner -Latest patient reviews

Monday, December 14th, 2015

r 1

I have been providing audio visual services for medical conferences over 25 years. As a result I am on-site and am able to see the latest developments and technology in surgical procedures when servicing these meetings. I had the opportunity to speak with a number of Canada’s top Ophthalmologists about laser vision correction surgery at their advice I decided to wait until the technology was sufficiently developed and proven. When I finally decided to have this surgery I took the advice of the aforementioned physicians and chose Dr. Raymond Stein to do this delicate and extremely important procedure. When I am providing Audio Visual and the topic of laser vision correction is on the academic program for a conference it is always Dr. Stein presenting to his fellow ophthalmologists. He is considered a well regarded and highly esteemed physician.

It has been a month since having the surgery and I am very happy to not have to wear glasses anymore. My long vision is improving every day. I was able to read text on a computer within seconds of having the procedure done. There was no pain during the surgery and I did not need the pain medication that was given to me after the procedure. The process was clearly explained to me and I found it all to be remarkably simple and straightforward. The instructions, after care package and follow up were comprehensive and easily manageable.

I would recommend this surgery to anyone considering it and I would highly endorse Dr. Raymond Stein as the surgeon to turn to.


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I had my Lasik done in 2003 by Dr. Raymond Stein. It was the best thing to ever happen to me. My prescription was -9.00 in both eyes, so I was nearly blind ! The staff took the time to explain everything that was going to happen on the day of surgery and what to expect afterwards. Dr. Stein is gentle and very calming. He’s perfect if you’re a big chicken like me. Afterwards my eyes were scratchy and squinty for about a day and a half, so I just napped at home and relaxed. Surgery on Thursday, and back to work on Monday. My eyes had been dry for most of my life, so I was told to expect a little extra dryness. No problem, I brought drops to work and they took care of it. About three or four months later I realized that they were back to normal. Now I only need drops once or twice a year during the winter when the air is really really dry. I was told that I might have a higher chance of needing a touchup because of my high prescription, but I’m still 20/20. I was also warned that when I hit the dreaded 40th birthday I would start to lose the reading vision, but that happens without the surgery too. All in all I’d recommend The Bochner to anyone who wants to change their life !


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Dr. Ray Stein performed my LASIK surgery a few summers ago. Prior to my surgery, my prescription was getting worse and worse and my eyes had pretty much rejected my contacts for the last time. Although I occasionally liked glasses as a fashion statement, they were a serious impediment to my life! I like to swim, sweat, snorkel, go outside on a sunny day without wearing ugly prescription glasses, and yes, see my alarm clock without squinting or fumbling for my glasses! I am a self proclaimed medical wuss…white coat phobic to the max. Deciding to do this surgery was a major source of stress and anxiety for me. The staff and Dr. Stein really helped me pre, during, and post surgery. The procedure was well explained, and I felt cared for. The actual laser took only seconds to work its magic. Quick. I was shocked that I posed for a picture with my eyes open minutes after my surgery. Being from out of town, my follow up care was done with my own optometrist. I’ve had 20/20 vision since then (although it did take a few months for the “haloing” around lights at night to disappear)…which I’ve been told was normal. I have and most definitely do recommend lasik surgery at Bochner. I seriously regret not getting it done sooner. Now if only there was a treatment for reading glasses! What are you waiting for?


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I was referred by my eye doctor to Dr Raymond Stein for LASIK. I was apprehensive but when I went for my consultation the staff made me feel comfortable and answered all my questions. The clinic is very busy with patients being referred from all over North America. When I went for my procedure I met a patient from Florida and another from Minnesota. They obviously have a good reputation! The surgery went very well and Dr Stein made me somewhat relaxed. Now a few months after my procedure, I can say it was one of the best decisions of my life. Freedom from glasses and contacts is awesome. A BIG THANKS to Dr Raymond Stein and the Bochner Eye Institute.

Seeing Distance & Near – Imagine life without Glasses or Contact Lenses!

Tuesday, October 20th, 2015

eyeLife without glasses or contact lenses. Yes, it is possible today! There are exciting new choices to improve your vision. Imagine using a computer or reading your smart phone without the need for glasses. You have the potential to drive a car, participate in sports, or watch a movie all without the need for any optical aids.

Two of the most exciting new developments are the SymfonyTM lens that recently received Health Canada approval after years of clinical studies and the Mplus implant from Europe. These lens implants, can be used at the time of cataract surgery or even if your lens is perfectly clear. This latter procedure is referred to as a refractive lens exchange. As we get older, our lens inside our eye becomes stiffer and dysfunctional. A stiffer lens is unable to change its shape to focus light. This leads to difficulty with both reading and intermediate vision.

A lens replacement procedure with an implant like the SymfonyTM or MPlusTM has the potential to sharpen both your distance and near vision. The SymfonyTM lens has unique optical properties to increase the depth of focus to allow you to see both near and far. The MplusTM is a segmented bifocal lens that allows a full range of vision. These implants can be inserted in your eye through a microscopic incision of around 2 mm. No needles or sutures are required. Not everyone is a candidate for the procedure, and hence an in-depth consultation is required to be sure your eyes are otherwise heathy. Some patients may experience glare and/or halos. This is typically mild and decreases over time. At the Bochner Eye Institute, all consultations are free of charge. Just call Bochner and let us know your interest in regaining your vision.

 

Amazing Feedback on Patient’s Experience at Bochner Eye Institute

Tuesday, 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

Read what our patients are saying

Monday, February 2nd, 2015
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Click to read more..

Multifocal Implant Cataract or Refractive Lens Exchange with the Mplus Implant

Friday, 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

Friday, 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

Friday, 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

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

Friday, October 17th, 2014

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Lessons Learned in Treatment of Keratoconus by Raymond Stein MD

Tuesday, 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