Raymond Stein Toronto Eye Surgeon as seen in “Style By Jury” Episode 146 Cruise Him or Loose Him (Brenda)
March 30th, 2010Dr Ray Stein in Style By Jury- Growing Pains (Amanda)
March 30th, 2010Raymond Stein MD Toronto, Canada as seen in Style by Jury “Mal” Man no More (Taffee) Episode 143
March 30th, 2010Dr. Raymond Stein Toronto of the Bochner Eye Institute in Style By Jury (Episode 126: A-Zar is Born)
March 29th, 2010Epithelial Basement Membrane Dystrophy (EBMD)
January 20th, 2010Dr. 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.
Computerized Topography to Rule-Out Keratoconus Prior to LASIK
January 20th, 2010In 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.
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Femtosecond Laser versus Microkeratome for LASIK
January 20th, 2010Dr. 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.