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.

Dry Eyes

Dry eyes can drive patients and doctors crazy.  We all want the same thing--to see everything perfectly clearly 24/7 and to not be bothered by our eyes.  But when problems happen with our tears, then this perfectly balanced system causes all kinds of problems.  Even with problems of blurred vision 5% of the time, that would be enough to bother someone on a daily basis.


Our eyes need to be moist to be happy.  Just think of the last time your nose was stuffy and you slept with your mouth open.  My morning, the throat becomes raw and sore.  On top of that, the eyes have more nerves for pain reception and sensation than almost any other part of the body.  Tears are important because of their special properties.  They are made of water, mucus, and fats that in the right mixture, coat and protect and provide a brilliantly perfectly smooth surface that helps to bend light and start the magical process of sight.


As we get older, this system can start to break down and because it is so complex, there are a lot of ways to treat it.  Unfortunately for some, all of our current methods are not enough and for these unlucky people, they have to fight on a daily basis for comfort and vision.


We have been very happy with our initial results for the Intense Pulsed Light Treatment for dry eyes.  So far, our patients are more comfortable with better vision and using fewer drops.  I'm excited with what we can do!

Cosmetic Eye Services

A quiet revolution is taking place in the world of facial cosmetic surgery.  The old view reported that over time, the structures of the face sag, there is too much skin, and we have to operate to remove and tighten.  While surgery still plays a role, the new approach looks at the whole picture and attempts to prevent aging changes by using non surgical techniques to enhance the appearance and only to use surgery carefully to complement the face.  

There are now so many options to help you retain a youthful appearance, and I am excited about bringing the latest technology and techniques to my patients.  Here is a brief overview of some common treatments.

Sunblock

Your skin ultimately is the foundation to all facial beauty and the number one problem faced by women is aging due to sun exposure.  By now, everyone knows that tanning and UV light damages the skin and causes premature aging.  In fact, being in Chicago where we have four full seasons actually makes many of our faces look younger and better than Americans tanning all year round!

My first recommendation is a daily moisturizer with SPF protection.  Be careful not to overdue tanning of the face and use hats and liberally apply sunblock when appropriate.  I tell my patients to use their favorite spas and salons to keep their facial skin in tip-top shape.
Latisse
Ophthalmologists have been using the parent medication in Latisse for over a decade and are very familiar with it.  I love what Latisse does for lashes and every single woman will have bigger thicker and darker lashes.  We check all of our patients for potential issues and discuss problems.  The best part is that there is no long term effects and you can stop at any time.  If you don't want to do this all the time, then pick a special event or holiday and start Latisse a few months before.  It's worth a try.

Botox

For women who are curious but have never had any cosmetic procedures, I recommend Botox.  Botox treatments make everyone happy.  They decrease the frown lines between the brows, relax the laugh lines arounds the eyes, and smooth out the forehead.  It is important to remember that they don’t remove wrinkles, but only help to prevent skin from folding when our facial muscles work.  People who have never had Botox often worry that their face will have no expression.  A proper Botox treatment would never do this.  In fact, one of my clients was a dancer who felt that it was critical to have nuanced facial expressions as she danced.  I carefully adjusted the dose and location of Botox so that she was overwhelmed with the final result.  It is a very safe treatment that universally improves your appearance.

Fillers

We now know that aging changes involve a loss of facial volume.  Look at how round and pudgy a baby’s face looks.  As we get older, the soft spongy material in our skin gets depleted.  As the skin loses volume, the tissues start to sag.  To combat this, aesthetic surgeons are now using dermal fillers to help retain the youthful face.  The safest fillers are made of hyaluronic acid.  Hyaluronic acid is a naturally occurring substance found in all mammals that helps to hydrate and add volume to your skin. In addition to its use as an aesthetic treatment, hyaluronic acid has also been used for more than 20 years for injection into arthritic joints to aid movement as well as for eye surgeries and wound repair. All of us have hyaluronic acid in our skin. By using only natural substances, there is a very low chance of an allergic reaction.

The treatments are fairly painless with minimal downtime and provide instant improvement in many areas of the face. Furthermore, since there is no permanent alteration, there is almost no risk of lasting problems. It is an excellent alternative to facial cosmetic surgery.

While many spas’s offer fillers by trained technicians, I have found that more advanced techniques that involve injecting around the eye are generally performed by surgeons.  The trend by eye surgeons is to help all areas around the eyes by using these materials.  

Blepharoplasty

Blepharoplasty, or commonly known as an “eyelid lift,” is a surgical procedure to remove excess skin and fat of the eyelids. With age, the facial skin will ultimately droop. Excess skin on the upper eyelid can form a ’hood’, which hangs from the upper eyelid to the point of resting on the lashes. Excess skin and fat on the lower eyelid can lead to a ’baggy’ appearance.  When Botox and fillers are not enough, then surgery is the next step.  Surgery is an excellent way to reverse these changes. It is the third most common cosmetic procedure for both men and women. Surgery is outpatient, takes about one hour, performed under mild sedation, and is successful over 90% of the time.

Lazy Eye

I recently saw a baby who had crossed eyes and only used his right eye to see.  With some devoted patching by the mother, the baby began to see out of his left eye within one week.  This miracle still captures my imagination.  While my children are long grown now, here is another one of my old newspaper articles about a medical condition known as amblyopia.

My two year old is on a mission:  search and destroy Daddy’s glasses.  Whenever I lay them down, he stops whatever he is doing and runs over.  His eyes scan my face to make sure I don’t see his intentions.  Then he slowly stalks my glasses.  Usually, my military training takes over and a command and control voice saying, “NO!” is enough to deter him.  Sometimes, however, I do not see his approach.  As soon as my fragile wire and plastic spectacles are in his tiny hands, his feet start stomping in a victory dance and he scampers away to hide the loot.

One of the most fascinating therapies in pediatrics happens everyday, but never gets much attention.  Thousands of children across the country have a condition known as amblyopia, or the more common description, lazy eye.  Why do they call it lazy eye?  It’s a vision problem that happens in children a perfectly normal eye doesn’t see 20/20 even with glasses.  The eye is okay and yet the child cannot see because of brain development.

Although there are many different reasons for such a situation, one major cause of lazy eye is when both eyes are not straight.  Eye movement is a complex dance that requires more choreography than any Broadway musical.  Each eye is controlled by six different muscles and three separate nerves that come directly from the brain.  This control is further complicated because we have two eyes that must dance in step.  They have to move together to give us stereo vision.  Some hefty computing power in the brain makes all this happen.  If this system is just a little off, if the “wiring” is hooked up the wrong way, the child may develop crossed eyes.

Now the child's brain is faced with a dilemma.  It receives two different images.  Anyone who has ever experienced double vision will understand how confusing and disturbing this can be.  Little children don’t understand, but their brains work overtime to help them cope.  If the brain is confused by what it sees out of both eyes, then it may just ignore all the information that comes from one of the eyes.  If this happens for any length of time, the parts of the brain devoted for vision doesn’t develop properly.

Whatever the cause, children with amblyopia have brains that don't pay attention to the signals from an otherwise normal eye.  Despite all the fancy lasers and surgical technology that has developed over the years, the treatment is still simple.  If the brain is ignoring one eye, let’s retrain it.  A simple eye patch, like a pirate from the high seas, can cover the good eye.  Now the small child’s brain has to make do with the situation.  Over a few weeks to months, the brain literally changes.  Nerve cells make new connections.  Other cells start receiving signals that they didn’t get before.  The child begins to see again with his lazy eye.

This is not easy to do.  I always tell the parents that they are about to go into battle.  We take a child that sees out of one eye, and with a patch, suddenly we make that child go “blind” until their second eye starts to see.  Miraculously, these children do recover vision.  Now if only I can find my glasses, I would be able to see again.

Cataract Surgery

When I was a major at Scott AFB in downstate Illinois, I was also a weekly science columnist with the Belleville News-Democrat.  I wrote several columns about medicine and especially about ophthalmology. In posting this column that was written over a decade ago, I was surprised to see that while the surgery has improved by leaps and bounds, the essential magic of cataract surgery was still present.

With the continual debate over national health policy, something seems to have been forgotten.  Miracles are taking place.  Every day, in every city, modern medicine is performing miracles.  Surgeries that would have been impossible a few years ago are performed in community hospitals.  These “miracles” have become so commonplace that we forget what has been accomplished.

Cataract surgery is the most commonly performed operation in the United States.    The days of the Coke bottle lenses are gone.  Fear of blindness from this condition is virtually eliminated.  These days, everybody has a relative or friend who has had this operation.  Yet, most people are not exactly sure what is done.

The eye is truly like a camera.  A cataract is a dirty lens.  It can distort the vision, cause glare, blur words, and turn white into dull gray.  The surgery removes the dirty lens and replaces it with a man made implant (a bionic eye as one of my patients puts it).

How does the lens come out?  There is no such thing as laser cataract surgery.  In some patients, a laser has to be used AFTER the surgery.  Instead of a laser, current techniques use the same energy that the obstetrician uses to find out the sex of unborn children--ultrasound power.

I like to use a grape model to explain how we operate on the lens.  First we take a tiny needle and tiny tweezers and tear a small circle of grape skin off.  Then we take a tiny ultrasound hose which shakes and sucks out the grape part.  A little bag of grape skin is left.  A small piece of plastic or silicon is then put inside this bag as a replacement lens.  The bag holds this lens in place just like the original lens.  Vision is restored.  I hope this explanation doesn’t spoil your taste of grapes.

The technical aspects are interesting but they don’t tell the whole story.  My excitement occurs in the following days when people begin to see again.  As one of my patients said, “You know, as I get older, everything gets worse.  From my arthritis to my hearing, I seem to be breaking down.  That’s why it’s so special to have something get better.  I see like I used to years ago.”

That sums it up better than I could have done it.  The miracle is the magical rejuvenation of sight.  Sadly, millions of healthy people in the rest of the world are totally blind from cataracts.  Many are forty to fifty years old, in the prime of their lives, and yet they cannot work, cannot see their children, or cannot even see a doorway.   The newspapers report on the aging of America, but in reality, the world is aging.  Let us hope that miracles will take place there as well.

IPL

We met with Rolando Toyos to kick off our new IPL treatment for dry eyes.  All the staff physicians and technicians learned about how difficult life with dry eyes can be.  Some people have suffered for years and after seeing many doctors and trying everything available, they give up on the hope that their eyes will ever be normal.

We performed IPL on four patients and the amount of secretions we were able to express from the eyelids was impressive.  I really believe this will change a lot of lives and make a huge improvement in my ability to take care of my dry eye patients.

Welcome

This is to allow me to talk about the rapidly changing world of ophthalmology and eye care.  The advancements are coming so fast that it is hard to keep my patients informed and so I've started this more informal blog.  Hopefully this will be an adventure for all.