Blepharospasm

When you hear the word Botox, cosmetic surgery quickly pops into your mind.  But Botox originally was originally approved by the FDA for medical conditions.  In the 1960's, an ophthalmologist in San Francisco, Alan Scott, pioneered work using Botox for crossed eyes and for a rare condition called blepharospasm.  I have treated Blepharospasm for over twenty years, and it continues to be a strange disease that troubles one person out of every 20,000.

Imagine losing control over your facial muscles.  People with blepharospasm have twitching of the muscles around both eyes and end up blinking uncontrollably.  Sometimes it is so bad that they can't even open their eyes.  Stress, lights, or other irritants can set off these spasms.  Since we normally talk with other people by looking them in the eye, this constant blinking and twitching causes embarrassment and distracts from everyday interactions.  Before the discovery that Botox can stop this twitching, these patients sometimes endured surgery where the muscles that cause blinking were removed from the face.

Today, we have effective treatment that improves the quality of life for all these patients.  Unfortunately, it sometimes takes years before they are referred to the proper specialists.

Recently, the CDC has recommended that all patients who receive Botox get a freshly mixed bottle and that multiple people should NOT be treated from the same bottle to avoid any chance of contamination.  At Dupage Ophthalmology, we are experts in treating hemifacial spasm and blepharospasm with Botox.

Board Certification

Last week, the mail brought great news for me.  I passed my American Board of Ophthalmology (ABO) Certification test.  The test culminated a multi-year process to re-certify.  Most patients don’t realize that physicians have to constantly attend lectures, review their charts, and take exams to keep the title of Board Certified.  Organizations make these standards for every specialty in medicine and most doctors must recertify every ten years.  After practicing for twenty years, this is my second recertification process.  

This whole process of testing physicians began about twenty-five years ago.  Before then, doctors became Board Certified for life and never had to provide proof of competency.  Patients can look up to see if their doctor is board certified by following the link to the ABO above.  As for me, there is no time to rest.  Medicine moves so fast, that we as physicians, have  duty to our patients to constantly keep up and improve.

Laser for Glaucoma

Medicine, like culture, tends to have shifts in philosophy. For a long time, for every patient complaint, there was a medicine to cure it. Unfortunately, this approach has led to an unreasonable number of pills and drops that patients have to take everyday. Beyond the burden of taking so many pills, the ever growing cost and possibility of side effects led to a widespread problem of patients simply not taking their medication as directed.

For an eye doctor, our patients take drops and although we don’t have many serious side effects, simple drops are not so simple. First of all, many people have trouble just squeezing the bottle and getting the drop to fall correctly on the eyeball. Some of these drops cost $1.50/drop and many times, they are being wasted on the patient’s cheek! Finally, they can burn and irritate our sensitive eyes.

All of this has led to a change in how Dupage Ophthalmology takes care of our patients with glaucoma. Although we can prevent blindness, this disease, more than any other, requires a lifetime of drops. Therefore, we are now doing everything we can to lessen this burden.

Using laser to treat glaucoma is an excellent option. The most advanced of these laser procedures is called Selective Laser Trabeculoplasty (SLT). This amazing procedure delivers microscopic laser spots to the drainage system of the eye. Often, patients develop a 20% reduction of eye pressure that can last for years. The laser has been in use for over a decade and we have extensive experience in its safety and effectiveness.
Our patients have been very happy with their SLT experience at our Lombard office. With a one time procedure, they can treat their glaucoma without the daily burden of drops. Since insurance covers the cost, this is less expensive than drops for both the patient and the insurance company. A win-win situation!


SLT has the same effect as the leading drop

Laser Cataract Surgery

I’m excited to announce the beginning of Laser Cataract Surgery coming to the Elmhurst Outpatient Surgery Center.  My partner, Dr. Sheridan Lam, and I have been working for months to bring the Catalys Femtosecond Laser to Dupage County.  We are at the beginning of a revolution in cataract surgery and now our patients will be among the first to reap the benefits.

 

Every decade or so, a new method of surgery is created that completely changes everything and this new method of using a laser is just so revolutionary.  While I will get into the specifics of what all we can do, let me start a series of posts by simply explaining what will happen.

 

This is true robotic surgery.  When I perform this, I won’t be holding some laser scalpel in my hand.  Instead, my patient will literally dock their eye into a sophisticated laser machine complete with visual scanning system that looks deep into the eye.  I will program what cuts need to be made into the cornea (where, what angle and shape) and how I want the cataract to be cut up.  Then the laser machine, in a few minutes, will make precise cuts into the eye and into the cataract lens.

 

Afterwards, the patient will be prepped and moved to the microscope where I will perform the cataract surgery.  The difference is that the eye has been fully prepared, the cataract has been “softened” and the whole surgery will be safer, faster, with less energy delivered to the eye structures leading to a faster recovery and better outcome. 

 

The new Catalys laser has been delivered to Elmhurst.  I can hardly wait to start!

Quality Delivered

Good Samaritan Hospital recently had a celebration dinner and fund raising event in honor of winning the 2010 Malcolm Baldrige National Quality Award.  It is the only formal recognition of a public or private organization in any field given by the U.S. Government.  Only a few health organizations have won this prestigious award and  I am very proud to belong to an organization that is so committed to quality.  All the physicians at Dupage Ophthalmology belong to the medical staff at Advocate Good Samaritan Hospital and are active members of Advocate Physician Partners.

Our practice has always been committed to quality.  Dr. Sheridan Lam, my partner, was recently published in the peer reviewed journal of the American Society of Cataract and Refractive Surgery.  He presented the data in our cataract outcomes as we continue to refine our preoperative measurements.  The goal of cataract surgery is to remove the patient’s lens and replace it with a plastic lens (the IOL or implant).  The surgeon can select the power of the implant and can often make the patient see without glasses.

Various studies over the years have looked at how accurate surgeons can pick an implant.  As the surgical precision improves, the error rate goes down.  The goal is to get the implant to less than 0.5 diopter units.

National Health Service-United Kingdom study in 2009

• 61% of patients should be within 0.50 D

Dr. Neuhann and staff from Germany reported in 2011

• 80% of patients were within 0.50 D

Dupage Ophthalmology ongoing results 2011

• 98% of our patients are within 0.50 D
  90% of our patients are within 0.25 D

We strive for excellence and we never stop.  Our patients deserve the best.

Measure Once, Cut Once

I love technology, and as an ophthalmologist, I get to play with some fancy machines.  Our latest gadget is the Lenstar machine.  Whenever patients have cataract surgery, the surgeon has to select the power of a lens to put into the eye.  This can be very tricky because the eye is only about one inch long (about 24 mm) and we have to measure very precisely or else the power of the implant will be totally wrong.  The Lenstar revolutionizes our ability to measure so many things.  In a few minutes, we are able to have accurate information about the length of the eye, the width of the cornea, the amount of astigmatism and curvature of the cornea, and several other parameters.  These measurements can be to the hundredths of a millimeter in accuracy!  Combined with advanced computer programs and modern surgical techniques, I am amazed at our cataract results.  Over 95% of our patients are right on the mark and the rest are very, very close.  This makes cataract surgery rival LASIK surgery in how close we can predict our post-operative outcomes.  So every day that my patients see 20/20 without glasses, I am thrilled at how far we have come.  It’s truly a modern medical miracle.





Eagle Vision

When people talk about eagle vision, it is a perfect metaphor for the ultimate visual system.  Eagles, hawks, and birds of prey have the best sight of any animal.  Just the need to fly requires excellent vision, but when you have to spot your dinner on the ground and dive after it at incredible speeds, you will go hungry if you don’t see exceptionally well.

First of all, their eyes are enormous.  Our eyes take up 2 percent of our face, but these birds can have eyes that are 15-20% of their head.  Sometimes, their eyes weigh more than their brain!  They also have an extra eyelid that is transparent.  They can blink and still keep seeing.  Inside their retinas, there are other differences from us.  We have two special receptor cells in our retinas to convert light to electrical signals—the rods and cones.  Birds have an extra receptor cell that probably allows them to see colors that we could not even describe.

It doesn’t stop there.  As Sy Montgomery notes in her 2010 book, Birdology, the bird’s retinas are densely packed with these receptor cells.  In our eyes, a special area of the retina called the fovea contains our best sharpest vision.  We tend to have 200,000 cones/mm² but eagles could have over a 1,000,000 cones/mm².  This would create a world of such detail that we would need microscopes to approximate what they see.  Remember when you saw your first HD television next to a regular picture.  Imagine a few levels of detail beyond that and you can start to think how these birds see the world.