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Eye News Volume I Issue 10

d p · March 11, 2001 ·

Philadelphia / Bucks County LASIK Surgeon – Dr. James S. Lewis

Eye News Volume I Issue 10

Volume I Issue 10

Originally published, March 11, 2001

Laser surgery moves to the office

John Grablewski’s vision returns to normal after his office-based YAG capsulotomy.

Argon Laser Trabeculoplasty can replace drops in glaucoma

For years Ophthalmologists have used lasers to treat glaucoma. It was always considered a last resort prior to surgery.
Now studies suggest laser treatment should be used before drops in some cases.
Aqueous humor [see below] is produced by the ciliary body. It passes over the lens, through the pupil and over the iris. It drains from the eye via the trabecular meshwork. An Argon laser is applied to the trabecular meshwork to treat glaucoma.
When aqueous is produced too quickly or when aqueous is removed too slowly glaucoma results. If left untreated glaucoma can irreversibly damage vision.
Dr. Barry Fabriziani claims, “It would be better if patients could feel the increase in eye pressure. They would come to us and we could treat them before permanent visual loss occurred.”
Glaucoma remains a major National Health problem in the United States. Nearly 15% of the population over sixty has glaucoma. Populations with even higher risk include diabetics, smokers, and relatives of glaucoma patients.
Glaucoma can also attack the young. Although rare, children can be born with the disease. Males in their thirties and forties can have this serious condition. Afro-American males have the highest incidence of this sight-threatening disease.
“We must rely on routine examinations or glaucoma screenings to make the diagnosis”, explained James Lewis, MD. “Asking someone to take eye drops two or three times a day is problematic. Medications are expensive and most have side effects. Patients can easily forget to take drops. Compliance is a major problem.”
English Ophthalmologists were the first to consider argon laser treatment as first line management for patients with glaucoma. The excellent safety profile of this laser made it a reasonable alternative to drops. Studies supported their theory.
American specialists were skeptical but their independent research supported their conclusion. “We learned that argon laser treatment for glaucoma can be as safe and effective as drops”, Lewis continued. “Studies proved lasers were more cost effective for the patient and less expensive for the National Health Service in England.”
Fabriziani added, “The convenience of providing this service in the office is appealing to patients”. “I am relieved because their eye pressure is controlled and patients don’t have to buy drops and remember to take them throughout the day.”
Lewis said, “The lasers have become smaller, more efficient and affordable. Having them in the office is an incredible convenience for patients. It allows us to practice better medicine.”

Eye cross-section explains office-based laser treatment for glaucoma.

Hospital visits and lab tests are no longer required for removal of an “after”cataract

Interviews by CONNIE CORBIN

Patient comments the first day YAG laser was performed in the office:

Joan Dakota – “delighted the laser was available in the office…easier for my daughter, I spent hours at the hospital for the other eye”

Jackie Taglieber – “vision improved and perfect with glasses”

Mr. Osiol – “boy, that was quick”

Edward Yancheck – “vision very good…the worse part was coming down in the traffic”

Walter Capper – “Thanks doctor, can’t we do both today?”

Harold Bonenberger – “is it over, that’s it?…that didn’t hurt at all”

Mary Jane Moore – “nothing to it”

Marilyn Black – “that was very quick and easy, I want the other eye done”

Mary Cushman – “no pain, not boring and not more fun in the
hospital… being at the hospital was a frustrating experience”

Margaret Janson – “This was easy”

Dr. Elaine Husted – “This setting is always much nicer, your staff is always lovely”

Marilyn Black is comfortable after her successful office laser surgery.

Dr. Lewis believes in using the latest technologies and techniques in order to provide his laser eye surgery Philadelphia patients with the best possible vision correction results. This is why, in addition to LASIK, he also performs Epi-LASIK in Bucks County / Philadelphia. Other state-of-the-art treatments offered by Dr. Lewis include implantation of Visian ICLs in Philadelphia.

Eye News Volume II Issue 3

d p · March 5, 2001 ·

Philadelphia / Bucks County LASIK Surgeon – Dr. James S. Lewis

Eye News Volume II Issue 3

Personalized instrumentation for each
LASIK patient

The Moria One Disposable maximizes sterility,
efficiency, precision, and quality.

Bartell brings surgeons new technology

Moria S.A., a French company serving the needs of Ophthalmologists for 180 years merged with Microtech, INC of Doylestown, PA, in June, 2000.
Mike Bartell, president and founder of Microtech along with his partner Charlie Mastellone are now co-chief operating officers of the new company, Moria, INC.
“There is a strong emphasis on disposables for LASIK surgery throughout Europe”, Bartell stated in a telephone interview this week. “The labor-intensive sterilization requirements make the convenience of the Moria One Disposable extremely attractive.”
Brian Pirollo of Moria, INC., said, “The accuracy and reliability of this device are outstanding. Surgeons who have tried it are convinced almost immediately. Most feel it is well worth the increased cost.”
“With the Moria One Disposable no one has to touch and potentially dull the extremely delicate blade. High volume surgeons and even surgeons with a lower case load will be drawn to its benefits”, Bartell continued.
James Lewis, MD, Medical Director of Advanced Laser Vision thought the instrument would be ideal for select cases. “I never thought a LASIK flap could be so precise, reproducible, and clean”, said Lewis.
“Once I saw how well the Moria worked, I knew we had to provide this quality to every LASIK patient”, Lewis continued. “You just can’t measure the value of a faster recovery.”
Bartell broke new ground in 1987 when he patented the inserter for foldable intraocular lenses. It took 4 years for the FDA to approve these lenses and another four years of patent litigation before his contribution was recognized. Now virtually every foldable intraocular lens used during cataract surgery relies on Bartell’s innovation (and patent).
The housing for the Moria One Disposable blade is shown below. It arrives sterile, inspected, and assembled. It is custom ordered and adjusted for every patient and discarded after a single use. Cross-contamination, corneal toxicity, instrument damage and sterilization failure are virtually eliminated.
“Forget the ease of use and faster turnover, this simply cuts a better flap. It is thin, uniform, and reproducible. I love this thing…and so do the patients”, Lewis said.
Dr. Fabriziani saw the first round of post-operative Moria One Disposable patients twenty-four hours after LASIK. He claimed, “The worst vision I measured today was 20/20. Most of my patients were 20/15.”
“I am having trouble even seeing where the surgery was performed. The eye heals overnight”, Fabriziani continues.
“There is no secret that Mike Bartell is a winner. He remains humble despite his extraordinary accomplishments”, Lewis continued. “I am glad he has turned his attention to LASIK. We benefit from his almost intuitive assessment of quality. He will help all of us to be better surgeons.”

Housing for Moria One Disposable Microkeratome

Advanced Laser Vision becomes first to use Disposable Microkeratome Exclusively

JENKINTOWN, Pa_ “He [James Lewis, MD] is never satisfied”, according to Sue Cross, chief LASIK Coordinator. “If there is new technology and it works……you can bet we’ll be the first to have it”.
“We like the concept of disposable instrumentation”, said Dr. Marc Myers. Myers is the newest member of the LASIK team. “There is a reduced risk of DLK (Diffuse Lamellar Keratitis), cross-contamination, and instrument damage.”
Tuyet Wong, RN was one of the early patients to benefit from the new instrumentation. She is pictured below immediately after LASIK with her husband, Bruce Wong, MD.
Dr Wong, a physician and the new Vice President of Outcomes Research at Bristol-Myers also had LASIK at Advanced Laser Vision a year ago.
“We used the Carriazo-Barraquer [microkeratome] for Dr. Wong’s surgery“, continued Dr. Myers. “At the time, we thought it couldn’t get better than that.”
Tuyet and her husband have seen 20/20 (and sometimes 20/15) in each eye at every postoperative visit.

Robert Hayes (below) didn’t let the residual eyelid antiseptic stop him. He started to put his own microkeratome through the paces after he walked from the operating suite.
“Since we began using the disposable I’ve been amazed with the patient’s rapid visual recovery”, explained Dr. Myers.
Just minutes after LASIK Robert Hayes is focused on surgical technique. Perhaps he is planning a career change.

Robert Hayes tinkers immediately after LASIK.

Dr. Lewis is renowned throughout the greater Philadelphia as a highly talented eye surgeon. His reputation for excellence attracts numerous Philadelphia, Bucks County, Elkins Park and Conshohocken Epi-LASIK and LASIK patients every year. In addition to helping patients seeking laser eye surgery in Philadelphia, Dr. Lewis also has many years’ experience helping Visian ICLs Bucks County / Philadelphia patients realize their dreams of clear vision.

Eye News Volume I Issue 9

d p · March 4, 2001 ·

Philadelphia / Bucks County LASIK Surgeon – Dr. James S. Lewis

Eye News Volume I Issue 9

Volume I Issue 9

Originally published, March 4, 2001

Pediatric Ophthalmologist arrives

Martin Wilson, MD, Attending Surgeon at Children’s Hospital of Philadelphia, former Director of Pediatric Ophthalmology at Einstein Medical Center and former Assistant Professor at the University of Pennsylvania Medical School examines Jimmy.

Our town welcomes subspecialty eye care for children

PHOENIXVILLE, PA _ Pediatric eye care is an important part of our community’s needs.
Generalists like Dr. Barry Fabriziani explain, “Dr. Wilson is now in our office on a regular basis. It will dramatically enhance the care we provide for our children”.
As the father of twin six-year-old boys, Dr. “Fab” has gladly directed his pediatric patients to Dr. Wilson. “His experience, expertise, and compassion make me extremely comfortable”, he continues. “I know how important it is for me to take my own children to subspecialists when health concerns arise”.
Cyrus Mineo, MD, the founder of the Ophthalmology practice always insisted, “Children are not small adults. They have unique needs and they required special care”, he claimed. “We are blessed to have someone of this caliber in our own backyard.”
Dr. Wilson, who is still in his late thirties, has an impressive list of accomplishments. He was the principal investigator in the CHOP (Children’s Hospital of Philadelphia) retinopathy of prematurity study as well as the co-investigator in the National Collaborative Study. These grants exceeded 11 millions in research dollars.
Dr. Wilson is also the Director of the Consult Service at the Seashore House for Children. He voluntarily serves as a member of the board of directors at the Overbrook School for the Blind in Philadelphia, PA.
James Lewis, MD, who takes credit for finding Dr. Wilson say, “Marty has an unusual blend of bedside manner with real academic excellent. His depth of knowledge and expertise extend far beyond the norm”. Besides, Lewis continues, “It is about time we have someone in the practice losing hair as quickly as me”!
In addition to Pediatric care, Dr. Wilson is a specialist in strabismus. Strabismus or crossed-eyes can occur in adults as well as children. New techniques including adjustable sutures, Botox injection, etc., expand the range of treatment patients can enjoy without leaving the area.
Because Dr. Wilson spent years teaching Ophthalmology Residents at the University of Pennsylvania his depth of knowledge extends beyond Pediatrics. “While his heart is in Pediatric Ophthalmology and Adult Strabismus, he is well versed in most areas of general eye care” explains Connie Corbin, Practice Administrator of Phoenixville Eye Associates.
“A significant number of primary care physicians have already started referring patients to Dr. Wilson”, Ms. Corbin added. “He is loved by our staff and his patients. I think parents really prefer subspecialty care when it comes to their children.”

Mother and daughter sit relaxed during Dr. Wilson’s evaluation.

Martin Wilson, MD, respected
Pediatric Eye Surgeon from the University of Pennsylvania starts private practice in our community

Dr. Martin Wilson in the colorful optical department of his Devon office.

Martin Wilson, MD
Pediatric Professional Buildings
227 Lancaster Aveue, First Floor
Devon, PA 19333

610-293-1432

Dr. Lewis is a highly experienced LASIK eye surgery Philadelphia surgeon specializing in advanced forms of laser eye surgery, such as Epi-LASIK. To help patients who desire to achieve freedom form glasses but cannot undergo LASIK, he offers Visian collamer lens implants (ICLs). In fact, Dr. Lewis is regarded as one of the most highly skilled Visian ICL

Eye News Volume I Issue 8

d p · February 25, 2001 ·

Philadelphia / Bucks County LASIK Surgeon – Dr. James S. Lewis

Eye News Volume I Issue 8

Laser Clean Room eliminates contaminants during surgery

Microscopic environment controlled to optimize results

JENKINTOWN, PA _ The Mastel Laser Clean Room was designed to remove potentially harmful airborne debris from the LASIK operating suite. It works.
“I was happy with the added safety this unit provided my patients and staff. That would have been enough”, said James Lewis, MD, a LASIK specialist. “I didn’t expect this device to improve my clinical results.”
Lewis continues, “Doug Mastel insisted I’d have better post-operative outcomes…. He’s correct and now it all makes sense.”
During LASIK the excimer laser is applied in a series of pulses. After each pulse vaporized corneal tissue rises from the surface. Pulses occur so rapidly they hit the rising particles from the previous pulse. The laser energy delivered to the cornea is distorted and inefficient.
“It is like driving through fog. The headlights work but resolution is impaired”, Lewis claims. “Elimination of this particulate debris allows each laser application to remove the planned amount of corneal tissue without distortion.”
The Laser Clean Room creates a controlled microscopic environment for LASIK. The particles are absorbed before the next pulse is applied. This ensures stabilized corneal hydration and reliable excimer corneal sculpting.
“The hot buzz word today is eye tracker. Mastel uses fixation [see the handpiece below] and the best supercomputer I know to optimize placement of laser energy. That supercomputer is the union of the patient’s feedback and the surgeon’s years of experience. This helps explain the improved results.”, Lewis said.
“The patients are reassured because we help them hold their eye still”, claims Sue Cross, head LASIK coordinator. “I can feel their anxiety lift when they learn we are in total control.”
The fiber optic visualization system Mastel added took years to perfect. This enhanced view helps the surgeon.
“The light source included makes it easy to center the laser energy. This is fundamental for patients with large pupils and night driving concerns”, claims Lewis. “I can be certain the ablation is well positioned and the interface is immaculate.”
Mastel Precision is known for innovation and the development of quality products. A decade ago their diamond blades and Radial Keratotomy instrumentation was without peer. Doug Mastel and his brother are engineers and they closely supervise and direct all research and development.
“I am relieved there is still a place for this kind of pride, dedication, and perfectionism in our field. I feel like I have a partner in every surgery”, Lewis said.
Surgeons throughout the country are reporting an improvement in visual results using the Laser Clean Room. Many feel their enhancement rate is reduced because the surgical micro-environment had been made more uniform.
“There is less visual fluctuation, less regression, and greater accuracy now that I use it [Laser Clean Room] in every case”, Lewis stated. “I don’t think my staff or my patients would tolerate it any other way.”

Doug Mastel’s
device enhances LASIK safety for patients, staff, and your surgeon

RAPID CITY, South Dakota- LASIK is effective because unwanted corneal tissue is painlessly removed. The aerosilized material is called the plume.
Live oral polio virus has been found to survive and remain infectious in the LASIK plume. MJ Travella, a respected researcher specializing in the properties of the excimer laser plume has eliminated most of our worries concerning transmission of other serious disease entities.
Responsible surgeons protect their staff, their patients, and themselves with multiple safety mechanisms.
LASIK’s excellent history and safety profile are encouraging. Mastel, however, designed the Laser Clean Room to remove unwanted compounds. Their Ultra Low Penetrating Air (ULPA) filters remove 99.9999+% of particles down to one-tenth of a micron. Viral particles, carcinogenic hydrocarbons, and aromatic hydrocarbons are eliminated.
HEPA filters, common in other laser plume evacuators address only 98.7%. Material three times larger than those handled by ULPA filters get past the HEPA devices. These escaped compounds can enter the lungs and bloodstream.
“I can smell the difference”, said Debbie Breig. Ms. Breig, an outstanding scrub nurse who has worked at Wills Eye and has assisted in LASIK before joining Advanced Laser Vision.
“I am more confident that potentially dangerous debris is removed before it can reach the patients and the staff”, Breig continues.
Mastel has also added an carbon activated filter to the system. It removes non-biologic substances.
OSHA, the federal agency regulating safety in the workplace, recommends thorough excimer laser plume evacuation.

Dr. Jamie Ellsworth-Neiman is reassured that her LASIK was performed using the Laser Clean Room.

At Dr. Lewis’ state-of-the-art LASIK Philadelphia offices, patient safety is of the utmost importance. This is why he uses sophisticated equipment for microclimate control and enhanced precision of surgical procedures. This approach has helped Dr. Lewis establish a reputation as a leading Philadelphia / Bucks County Epi-LASIK, LASIK and Visian ICL surgeon.

Eye News Volume II Issue 2

d p · February 25, 2001 ·

Philadelphia / Bucks County LASIK Surgeon – Dr. James S. Lewis

Eye News Volume II Issue 2

State-of-the-art LASIK comes to town

Sue Cross (LASIK coordinator and patient advocate, left) assists James Lewis, MD (center) during laser vision surgery. Dawn Cacia, RN (right) prepares the microkeratome and Robert Czajkowski (first assistant, background) runs the Nidek EC-5000 computer and excimer laser.

Established local eye surgeons dominate laser vision correction services

“Patients need to know their surgeon and the practice to whom they entrust their vision, “ claims James Lewis, MD. “By the time you add the cost of pre-operative evaluation, post-operative care, and enhancements patients lose time and money.”
He continues, “Patients reason that an eye surgeon who has thrived in the community for years can be trusted to provide top caliber LASIK care. These same surgeons are more likely to be available years later if needed.”
A professional, personable and caring staff is fundamental to success. “Patients need warm fuzzies”, says Sue Cross, head LASIK coordinator. “They are scared. They have only one set of eyes. You need to deserve and earn their trust.”
“I am very proud when a patient chooses us after visiting several LASIK providers”, Sue continues. “My job is to support the patient before surgery, during the procedure, and throughout visual rehabilitation.”
“Patients are smart. They can tell when you believe in the procedure, the surgical team and the doctor”, continues Sue Cross. “Dr. Lewis has performed over 4000 LASIK procedures, including most members of our staff. I would let him operate on me but I am already 20/15”.

Dawn Cacia, RN and Sue Cross take their jobs seriously unless there is a photo opportunity.

Making sense of LASIK technology

“Broad beam lasers ignited the entire refractive surgery revolution”, says James Lewis, MD an experienced LASIK surgeon.
Broad beam lasers use an expanding circular beam to progressively remove tissue and reshape the cornea. The resulting ocular shape reduces or eliminates a patient’s need for glasses or contact lenses.
“We soon began to recognize flaws with this approach. Areas in the central cornea were not removed effectively and irregularities called central islands interfered with vision”, Lewis said. “We also realized broad beam lasers limited our range of treatment, caused excessive acoustic shock, and allowed vision threatening decentration…..As surgeons we wanted something better.” Lewis hasn’t used a broad beam laser in nearly two years.
“Outstanding optical engineers and laser physicists from the US, Japan, Germany, and Australia developed what we now considered modern excimer laser designs”, Lewis continues. “Flying spot lasers paint the cornea with small brushes. Scanning and flying slit lasers use different size rollers to ablate the cornea and reshape it.”
While some laser facilities have decided to simply upgrade or modify their broad beam lasers Lewis feels there is no future in that strategy. “New generation lasers permit more reliable results, faster rehabilitation, and a higher quality of visual function”, Lewis said.
Patients expect 20/20 vision. They also want to see well at night. Patients hope to experience less glare than they had with glasses and contact lenses. Modern excimer lasers may make this all possible.
“At first, I was intrigued by flying spot lasers. Unfortunately, in my view, they are not ready for prime time. Flying spot lasers take an extremely long time to treat the cornea allowing it to dry and warp during the process. Flying spot lasers also rely too heavily on eye movement tracking devices which can fail.” Lewis also claims, “these lasers are incredibly fragile and are still being refined”.
“Surgeons throughout the world have favored scanning and flying slit lasers. They are incredible capable, dependable and have a well-established track record.” Lewis claims.
Several of these advanced designs have been approved by the FDA. They are modular. “The Nidek EC-5000 has an elegant internal structure with sophisticated microprocessor control. The machine is made to grow as our knowledge of refractive surgery expands.”
As the Medical Director of Advanced Laser Vision, it is not surprising that Lewis selected NIDEK exclusively for all offices. He admits other respected surgeons in the region and elsewhere have followed suit.
“LASIK is great now and getting better every day”.

At Dr. Lewis’ state-of the art facilities, all patients are treated with the utmost attentiveness and dedication. This approach has helped Dr. Lewis establish a reputation as a leading Philadelphia, Bucks County, Elkins Park and Conshohocken LASIK and Epi-LASIK expert. In addition to performing laser eye surgery, Dr. Lewis also treats Philadelphia and Bucks County ICL patients.