Archive for January, 2010

Epithelial Basement Membrane Dystrophy (EBMD)

Wednesday, January 20th, 2010

Dr. Raymond Stein, in the article below, discusses epithelial basement membrane dystrophy that can hinder an individual’s vision. Along with the team at Bochner Eye Institute, Raymond Stein, MD, believes that patient education is important to rewarding eye care. For additional information about other eye care topics, please visit the other pages on this site.

EBMD is a common hereditary corneal dystrophy that may lead to recurrent corneal erosions and/or blurred vision. Clinical epithelial signs include fingerprint lines, map-like changes or microcysts. If the corneal signs are subtle, it is valuable to instill fluorescein and view with a Cobalt-blue light. With EBMD the epithelium is irregular and the tear breakup is often abnormal.

If patients have recurrent erosions and they are refractory to hypertonic solutions, (Muro 128 5% drops and/or ointment) then a keratectomy can be performed. This procedure involves debridement of the corneal epithelium and polishing of Bowman’s layer with a diamond burr. With this technique, 85 percent of eyes will have resolution of their erosions. The procedure can be repeated if necessary.

If patients have glare, halos, or reduced vision secondary to EBMD then a keratectomy is the best treatment option. The epithelium that grows back is usually smoother resulting in improved vision. Best vision is achieved within four to six weeks following the procedure.

To learn more about Raymond Stein and the skilled vision professionals at Bochner Eye Institute, visit www.bochner.com or call 416-960-2020.

Name
Email
Comments
Enter this code in the field below
Enter this code in the field below

Computerized Topography to Rule-Out Keratoconus Prior to LASIK

Wednesday, January 20th, 2010

In the article below, Raymond Stein, MD, discusses the importance of testing patients for keratoconus prior to their LASIK surgery. As a member of the distinguished Bochner Eye Institute team, Dr. Raymond Stein works closely with his colleagues to help ensure the highest levels of patient safety and satisfaction.

Keratoconus is a well-recognized contraindication to LASIK. The creation of a corneal flap and removal of tissue by an excimer laser can weaken the cornea. This can lead to corneal instability with progressive ectasia. Although there are a variety of clinical signs of keratoconus, the use of computerized topography usually detects the earliest stage of keratoconus. The most advanced topography units measure both curvature and elevation. At Bochner, the Pentacam is our unit of choice.

We typically make the diagnosis of keratoconus when one or more indications are present:
1.    Inferior steepening of greater than 1.5 Diopters compared to superior cornea.
2.    Elevation of the posterior cornea of greater than 17 microns compared to a best-fit sphere.
3.    Elevation of the anterior cornea of greater than 21 microns compared to a best-fit sphere.
4.    Central steepening of greater than 49 Diopters.
5.    Steepest corneal location associated with thinning of less than 500 microns.
6.    Advanced clinical signs include Vogt’s striae and apical scarring.

In addition to the clinical findings above, we are reluctant to perform LASIK if there is an immediate family history of keratoconus.

Careful preoperative evaluation prior to laser vision correction can greatly reduce the risk of corneal ectasia.

To learn more about the Bochner Eye Institute and Raymond Stein, please call 416-960-2020 or visit www.bochner.com.

View Raymond Stein on Style by Jury!

Name
Email
Comments
Enter this code in the field below
Enter this code in the field below

Femtosecond Laser versus Microkeratome for LASIK

Wednesday, January 20th, 2010

Dr. Raymond Stein believes that patient safety and satisfaction are paramount during  a LASIK procedure. In the article below, Raymond Stein, MD, discusses the benefits of femtosecond laser technology and why you should select a surgeon who uses this technology instead of  the traditional microkeratome.

Femtosecond laser technology, used to create the corneal flap during LASIK, is much safer and more predictable than microkeratome, which uses a metal blade. This is in part due to the shape of the laser flap, which allows us to create an evenly thick corneal flap, whereas the blade often creates a miscues flap that is thinner in the center and much thicker in the periphery. This can lead to one of the most dreaded LASIK complications, also known as the button-hole. It can result in loss of best-corrected vision from irregular astigmatism. When we first acquired the Femtosecond laser more than three years ago, we initially planned on offering both blade technologies. However, after discovering the benefits of the Femtosecond laser, we quickly sold the microkeratome. This is why we feel strongly about informing all prospective laser patients that the Femtosecond laser provides the safest technology with the best outcomes.

Why would laser centers today still offer inferior technology? The answer is very clear – cost. The purchase of a Femtosecond laser costs about $500,000, then there is an annual maintenance fee of approximately $70,000 and a disposable cost (suction ring) of $200 per eye. A microkeratome can be purchased for $35,000 or less, there are no annual maintenance fees and the cost of a blade is around $50 for both eyes. So you can see that significant saving are associated with inferior technology, which is why most laser eye centers still utilize the microkeratome.

Femtosecond technology continues to advance. At the Bochner Eye Institute we acquired the first IFS laser in Canada, which has a speed of 150 KHz. This is 2.5 times faster than the previous laser technology. This results in the suction ring being on the eye for less time, which leads to a more comfortable experience for the patient. In addition, the new technology can create a flap edge greater than 100 degrees. This leads to a more stable flap position, like a man-hole cover, which lowers the risk of epithelial ingrowth.

At the Bochner Eye Institute we continue to treat a significant number of eye-care professionals from across Canada and the United States. We feel this is because eye doctors understand leading edge technology and trust our surgical techniques and abilities.

To learn more about Raymond Stein and the team at Bochner Eye Institute, please visit www.bochner.com or call 416-960-2020.

See Raymond Stein Toronto on Style By Jury.

Name
Email
Comments
Enter this code in the field below
Enter this code in the field below

Phakic Implants for High Refractive Errors

Wednesday, January 20th, 2010

Raymond Stein, MD, has extensive experience helping patients throughout North America with their vision correction. In the article below, Dr. Raymond Stein discusses the benefits of Implantable Contact Lenses.

Phakic implants are used in vision correction for high refractive errors that cannot be treated with laser eye surgery. Over the past 12 years I have been inserting the Implantable Contact Lens (ICL), a posterior chamber phakic implant made by Starr Surgical. Clinical outcomes for high myopia and astigmatism have generally been excellent with 95 percent of patients achieving 20/30 vision or better.

The main indications for ICL candidacy are refractive errors that are too high for laser vision correction. In general patients are candidates for a phakic implant if they have myopia (nearsightedness) greater than 10 D or hyperopia (farsightedness) greater than 5 D.  Astigmatism can be treated up to 6 D. Patients must have a satisfactory depth of the anterior chamber (distance between the corneal endothelium and the crystalline lens) of greater or equal to 2.8 mm. In general, most patients with high myopia are eligible for this type of treatment, unlike individuals with high hyperopia. In addition, ICL candidates should also have a pupil size of 7 mm or less.

Another surgical option, which patients need to know about, is the refractive lens exchange (RLE) procedure. My preference is not to perform a lens exchange for patients suffering from high myopia because of the increased risk of retinal tears and detachment.  This is not the case with the treatment of high hyperopia, which is associated with a minimal retinal risk. This is why patients who suffer from extreme farsightedness and are not good candidates for ICL, often undergo refractive lens exchange.

Patients who are good candidates for the ICL, a refraction is performed, the limbal white-to-white distance is measured to determine the length of the implant, and two small YAG laser iridotomies are administered to reduce the risk of elevated intraocular pressure from papillary block. The implant is custom ordered from Switzerland.

The surgical procedure is relatively easy for most patients.  At the Bochner Eye Institute we perform this procedure in our sterile operating room approved by the Ontario College of Physicians and Surgeons. During the procedure, which is performed under topical anesthesia, a 2.8 mm limbal incision is constructed. Next, an Intraocular xylcaine is injected to numb the eye. After carefully folding the implant into a cartridge, it is injected into the anterior chamber where it gradually unfolds. Using a specialized instrument the haptics are gently placed behind the iris. Miochol is then injected to constrict the pupil and  Intraocular Vancomycin to prevent infection. Following this fairly simple procedure, patients remain at the surgical suite for about an hour during which time they are closely monitored, which allows us to ensure that the intraocular pressure is normal. Follow-up visits are generally necessary in intervals of one day, one week, one month and three months.

Complications following an ICL procedure are rare. There is, however, a 1 percent chance of inducing a cataract.  Also, patients who are not satisfied with the level of uncorrected vision are eligible to undergo laser vision correction. I have not had a case of infection over the past 12 years.

Specialized indications for the ICL include patients with keratoconus and those following radial keratotomy. Keratoconus patients who have satisfactory best-corrected spectacle acuity (20/40 or better) may want to consider ICL. Some patients may require an Intracorneal ring to reduce the degree of irregular astigmatism prior to a phakic implant. In addition, the hyperopic shift, which may develop in patients following radial keratotomy, can be corrected during the ICL procedure. This is because the post-RK eyes that were previously myopic usually have a satisfactory anterior chamber depth.

To learn more about Raymond Stein and how the team at Bochner Eye Institute can help you, please visit www.bochner.com or call 416-960-2020.

Name
Email
Comments
Enter this code in the field below
Enter this code in the field below

Dr. Raymond Stein on Salzman’s Nodular Degeneration

Wednesday, January 20th, 2010

Dr. Raymond Stein is a distinguished ophthalmologist at the Bochner Eye Institute. He has performed more than 80,000 vision surgeries and is the Chief of Ophthalmology at the Scarborough Hospital in Toronto. Below, Raymond Stein, MD, discusses Salzman’s nodular degeneration and how it can be treated.

Scar-like tissue, referred to as Salzman’s nodular degeneration, of the superficial cornea can be seen in the midperiphery or periphery. This corneal degeneration can result in a decrease of best-corrected acuity and lead to secondary to irregular astigmatism. Computerized topography can be used to confirm the induced corneal astigmatism.

The treatment is relatively easy for patients with a superficial keratectomy. Under topical anesthesia the superficial scar-like tissue can be gently peeled away from Bowman’s layer. A bandage soft contact lens is inserted and worn until the epithelium regenerates which is typically three to five days. An antibiotic and steroid are prescribed for one week. Best-corrected vision is usually improved within four to six weeks, at which time new eyewear can be prescribed.

To learn more about Raymond Stein, please visit www.bochner.com or call 416-960-2020 today.

Raymond Stein On Style By Jury

Name
Email
Comments
Enter this code in the field below
Enter this code in the field below