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Eye News Volume I Issue 7

d p · February 18, 2001 ·

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

Eye News Volume I Issue 7

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. James S. Lewis takes great pride in his reputation as a foremost LASIK Bucks County / Philadelphia surgeon. To serve the unique vision correction needs of each patient, he offers various forms of laser vision correction, such as LASIK and Epi-LASIK in Philadelphia. In addition, he specializes in helping Visian ICL Bucks County / Philadelphia patients realize their dreams of clear vision without glasses.

Eye News Volume I Issue 6

d p · February 11, 2001 ·

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

Eye News Volume I Issue 6

HRT II makes diagnosis of glaucoma scientific

Abnomal (glaucoma) eye

Glaucoma attacks the eight meridians of the optic nerve. The HRT II marks columns as normal with a green check. Borderline areas of the optic nerve have yellow exclamation point. Damaged regions are shown with a red X.

Damage to optic nerve and surrounding nerve fiber layer is shown by these same symbols in the photos above. Injury is suggested when the green line dips below the normal horizontal red threshold.

Normal eye

All meridian of this eye are marked as normal. Notice the green healthy neural rim dwarfs the red region of “cupping” in every column. This strongly suggests the absence of glaucoma and other optic nerve diseases.

This normal optic nerve has green check marks in all quadrants. Notice the green line never dips below the red line. This study shows a healthy eye. (The position of the red line or threshold is age and sex dependent.)

Statistical analysis fundamental to Heidelberg success

MOORFIELDS, England_ Statisticians at the world famous Moorfields Eye Hospital (http://www.moorfields.org.uk/) have helped eye physicians make sense of this hybrid computer and laser technology. Their work on so-called stereometric parameters allow eye care professions like Dr. Barry Fabriziani to treat local glaucoma patients.
Mrs. Dolores Causland, a longstanding patient of Phoenixville Eye Associates said she has never “understood the diagnosis of glaucoma suspect”. She was delighted by the informative explanation and immediate hassle-free test results.
“This examination is fantastic”, she continued. She was mesmerized by the ‘tremendous” new device.
“Technology has finally caught up,”, exclaimed Joyce Lammey, another longstanding borderline glaucoma patient.
Brenda Dubbs had her medication discontinued after years of use. The HRT II showed no evidence of glaucoma or optic nerve damage. She was ecstatic.
“I don’t know how I practiced quality eye care without the Heidelberg. I can validate my diagnosis with hard data”, said Dr. Barry Fabriziani, OD. “In the fifteen years I’ve been practicing I have never had this level of confidence”.
“Subjecting patients to years of unnecessary glaucoma medications is expensive, inconvenient, and potentially dangerous”, Fabriziani continues. “Patients can find themselves in the emergency room or even the intensive care unit from side effects common to many glaucoma medications.”
“Test results are stored digitally on optical magnetic media with an anticipated shelf-life of over 100 years. I have already filled the first 2.3 gigabyte disc. I am most excited by the ability to follow patients with progressive disease. Adjusting glaucoma medications has now become a scientific practice.”
James Lewis, MD, was invited to Santa Monico, California last week, for the annual Glaucoma Update. Dr. Lewis was one of fifty eye surgeons nationwide sponsored for the trip. He was asked to sign a non-disclosure agreement concerning pharmacologic glaucoma innovations and is required to limit his comments. He could say, “The Heidelberg is playing a prominent role in assessing the value of new glaucoma treatment”.
Dr. Fabriziani feels that “nearly all practioners who plan to manage glaucoma patients in the next decade will need the HRT II”. “It allows me to stop glaucoma therapy when it is unnecessary and start treatment when it is needed. The machine will undoubtedly reduce the cost and inconvience to patients who really don’t need medication.’
Most importantly, Dr. Fabriziani continues, “the HRT II will allow better longterm management of glaucoma patients”. “It should help our universal desire to eliminate glaucoma blindness in this country during our lifetime.”

Connie Corbin, practice administrator of Phoenixville Eye Associates verifies her retina and optic nerve are normal.

Dr. Lewis is renowned throughout the greater Philadelphia area as a highly skilled LASIK and Epi-LASIK Bucks County, Elkins Park and Phoenixville expert. At his elegantly appointed LASIK Philadelphia offices, patients can also undergo implantation of advanced ICLs, such as Visian ICL.

Eye News Volume II Issue 1

d p · February 6, 2001 ·

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

Eye News Volume II Issue 1

State-of-the-art LASIK comes to town

Scanning slit technology wins

DOYLESTOWN _ “International surgeons favor the scanning slit excimer for laser vision correction. The results are simply better” claims Barry Fabriziani, OD. Dr. Fabriziani has practiced in the community for over fifteen years and is one of the most experienced eye doctors in LASIK pre- and post-operative care.
“The advances in laser technology and Dr. Lewis’s extensive corneal experience have made me a strong proponent of LASIK as an important option for my patients wearing glasses and contact lenses.” Fabriziani says.
“The progress in excimer laser technology has been critical to the success of this procedure. LASIK is now mainstream”, Fabriziani feels.
The excimer laser was originally developed by IBM for use in the semiconductor industry. It didn’t take long before scientists realized it was remarkably accurate at shaping corneal tissue.
While some laser manufacturers concentrated their efforts on simplistic and now outdated broad beam techniques, NIDEK developed a sophisticated scanning slit approach.
“Instead of blasting away precious corneal tissue, NIDEK uses a software-driven design that scans the cornea and gently removes tissue. The slit paints the cornea and fashions the ideal optical shape”, said Dr. Fabriziani.
“The technology behind the NIDEK EC-5000 laser has been recognized internationally. I was sold on scanning-slit technology when I learned many experienced refractive surgeon’s chose the NIDEK when their friends and family needed LASIK” claimed Dr. Fabriziani.
Dr. Lewis will describe the progress of excimer laser technology in next week’s Intelligencer.

Laser frees area residents from their glasses and contact lenses

Interviews by
SUE CROSS

George Foley had surgery last week. His wife, Suellen Foley, is pictured just minutes after her LASIK procedure. Both enjoy 20/20 vision without glasses.

HUNTINGDON VALLEY _ “There were no surprises, the procedure was painless”, said Suellen Foley.
James Lewis, MD, performed her LASIK procedure last week. Mrs. Foley is shown above with her husband minutes after her laser vision correction.
“The next morning I saw the alarm clock and jumped out of bed”, she exclaimed. “I looked in the mirror to see if there were signs of the operation. I couldn’t see any evidence I had the LASIK surgery less than twenty-four hours ago!.”
Suellen was amazed. “Then I realized I was looking at my face without my glasses and I could see”, she continued. “The procedure was painless, there were no surprises, and I wasn’t nervous”.
Ms. Foley investigated LASIK providers in the area but she had a distinct advantage. She made her husband go first!
George Foley had LASIK by Dr. Lewis the week before. Mr. Foley said soon after his surgery, “there were no surprises and during the procedure I felt minimal discomfort. I am happy to drive at night without glasses”.
Suellen continued, “I wasn’t nervous and I am a walking advertisement for Dr. Lewis”.
LASIK is rapidly becoming the most popular eye procedure both nationally and internationally.
Many think LASIK is a modern version of RK (Radial Keratotomy) developed in the former Soviet Union. It isn’t! The true birthplace for LASIK is Bogata, Columbia.
In 1949, Jose Barraquer began sculpting the cornea to change its shape and reduce dependence on glasses and contacts. American scientists and physicians helped the international effort and refined the process. Thanks to brilliant intellects from Italy, Greece, South America, Canada, France, and the United States LASIK was born.
Dr. Carmen Barraquer (Jose Barraquer’s daughter) continues to make important contributions to the science of LASIK at the Barraquer Institute in Bogata.
The FDA, known for its conservative approach, first approved LASIK several years ago. Sources estimate nearly two million LASIK procedures will take place in the US alone in 2001.
Suellen and George Foley are happy to be in that growing number of local patients who have benefited from over fifty years of science, technology, and medicine.
Willis Houston (shown below) also had his LASIK surgery last week.
Mr. Houston reported, “The surgery was better than my expectations and I am thrilled that I was 20/20 on my first day.”
Like others, Mr. Houston is most excited he can drive without his glasses. He added, “the surgery has made me look younger”.
Dr. Lewis, who has performed over 4000 procedures in the last two years said, “I am always amazed with the feeling of freedom these patients describe. It is like they have been held back from enjoying life, sports, and hobbies by their glasses and contact lenses”.

Willis Houston also had his LASIK surgery last week.

At Dr. Lewis’ elegantly appointed LASIK and Epi-LASIK Philly offices, patients can choose from a variety of advanced vision correction treatments. In addition to performing laser eye surgery, Dr. Lewis specializes in implantation of collamer intraocular lenses and is renowned as one of the leading Philadelphia Visian ICLs experts.

Eye News Volume I Issue 5

d p · February 4, 2001 ·

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

Eye News Volume I Issue 5

Breakthrough in glaucoma diagnosis and management

New test helps area physicians win battle against glaucoma

PHOENIXVILLE, PA, _ Dr. Barry Fabriziani can’t hide his excitement after the arrival of the new HRT II from Heidelberg, Germany. He beat out other eye care providers by obtaining one of the first units of this groundbreaking technology.
Dr. Fabriziani is no computer expert. This may have to change. “We have needed something like this in glaucoma for years. I can take a snapshot of my patient’s optic nerve in seconds. The test doesn’t require eye drops and there is no discomfort. I get a detailed three dimensional picture to guide diagnosis and management”, Fabriziani claims.
The HRT II is a more friendly descendent of the original HRT research tool developed ten years ago. It records the exact size and shape of the optic nerve and the nerve fiber layer of the retina. Complex imaging and statistical software helps the physician treat glaucoma.
Glaucoma attacks over 15% of the population past the age of sixty. It results in blindness in far too many patients. Advanced glaucoma has been detected in unsuspecting individuals in the forties and younger.
Measurement of the pressure within the eye, drawings of the optic nerve, and computerized visual field tests have been the foundation of glaucoma management for years. Nevertheless, even the best doctors admit they miss some cases and over diagnose others.
“In the first week I initiated glaucoma treatment in three patients who had damage that was too subtle to recognize before the HRT II. I’ve also stopped medication in five patients who, probably, never needed treatment”, said Fabriziani. “The real benefit of this machine will be evident in six months. I will re-evaluate the optic nerve and know if the glaucoma drops are working.”
The cost of glaucoma medication is high. The cost of preventable blindness from glaucoma is even higher. The government, pharmaceutical companies and the insurance industry recognize the need for better glaucoma care.
“Patients can’t always cooperate fully with visual field testing”, Fabriziani continues. “It is frustrating. A bad test may mean worsening glaucoma or it may represent nothing more than a patient bored by the 45 minute visual field examination.”
A number of other eye care providers in the area have started to send their patients to Dr. Fabriziani for a scan. “Some doctors have six months to wait before their HRT II arrives. Others don’t have enough glaucoma patients to justify the cost of the technology. Most recognize the need for a yearly HRT II scan for their patients with glaucoma”, Fabriziani adds.
“I’ve seen him twice in the last week”, said Dr. Maria Parisi, former chief of Pediatrics at the Pennsylvania College of Optometry. Dr. Parisi, who remains active academically in the field is also excited by this new technology. Nevertheless, she hopes her husband (Dr. Fabriziani) will, “come home soon to visit the twins, Joshua and Jonathan.”

Estelle Solomon widow of beloved Macey Solomon, MD, has details of her retinal status explained by Dr. Fabriziani.

Nerve fiber key to glaucoma

HEIDELBERG, Germany _ Orange-red laser light was used in the original HRT nearly a decade ago. This device scans the eye and creates three-dimensional images in seconds. The “picture” contains sixty-five thousand data points. This confocal retinal scanning microscope resembles a CAT-SCANNER dedicated to the eye.
The HRT II, an updated, patient-friendly model, was recently approved by the FDA and validated by Medicare and other major insurance carriers for clinical use. They have covered its cost for patients with glaucoma and related conditions.
Phoenixville Eye Associates has obtained one of the first units in the Delaware Valley. One hundred patients have been scanned in the first week and a special schedule has been established for the backlog of glaucoma patients needing care. The extraordinary benefits of this machine have created a six month backorder for the manufacturer from physicians and practices in the US.
Scientists and researchers at Moorfields, England as well as contributors from the United States have made extremely early diagnosis of glaucoma by the HRT II possible. Application to macular (retinal) disease and ocular melanoma have also been developed.
The nerve fiber layer is attacked early in glaucoma. Until now, damage to the nerve fiber was extremely difficult to diagnose. The HRT II measures this layer precisely. It helps the doctor verify glaucoma before irreversible loss of the visual field occurs.
Next week, the statistical analysis capabilities of the HRT II will be featured in next week’s Eye News.

Sample HRT II analysis of glaucoma suspect patient.

Stereometric Results	ONH 0 – 360
Disk Area:	1.456 mm
Cup Area:	0.241 mm
Cup/Disk Area Ratio:	0.170
Rim Area:	1.175 mm
Height Variation Contour:	0.338 mm
Cup Volume:	0.044 cmm
Rim Volume:	0.304 cmm
Mean Cup Depth:	0.167 mm
Maximum Cup Depth:	0.688 mm
Cup Shape Measure:	0.364
Mean RNFL Thickness:	0.243 mm
RNFL Cross Section Area:	1.026 mm
Classification:	Normal (2.69)

Dr. James Lewis has multiple years’ experience treating Philadelphia and Bucks County laser eye surgery patients. In addition to his LASIK expertise, Dr. Lewis is also renowned throughout the greater Philadelphia as an accomplished, compassionate Epi-LASIK Philadelphia expert. For individuals who desire to achieve freedom from glasses but cannot undergo LASIK, he offers Visian ICLs in Bucks County / Philadelphia.

Eye News Volume I Issue 4

d p · January 28, 2001 ·

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

Eye News Volume I Issue 4

First class surgical team assembled for LASIK

Sue Cross (LASIK coordinator and patient advocate, left) assists James Lewis, MD (center) during laser eye surgery in Philadelphia. 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

PHOENIXVILLE, Pa, _ Respected ophthalmic surgeons in our region continue to maintain the trust of patients seeking LASIK surgery.
Large corporate vision centers and discounters are not thriving in our area. High powered celebrity endorsements and bargain-basement promotional fees have not helped.
“Patients need to know their surgeon and the practice to whom they entrust their vision, “ claims Dr. Barry Fabriziani. Fabriziani has managed refractive patients in our community for over a decade. “By the time you add the cost of preoperative evaluation, postoperative 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.”

Michele Detwiler welcomes all patients to Phoenxiville Eye Associates.

Michele Detwiler says, “This job is fun. Patients are excited. Their happiness after surgery is contagious….I love it here.”
“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. — Dawn Cacia, RN and Sue Cross take their jobs seriously
unless there is a photo opportunity.

“We have a very strong surgical team”, according to Robert Czajkowski, licensed first assistant and chief laser technician. Robert has extensive operating room experience. His last position was operating room scrub nurse at Wills Eye.

Dawn Cacia, RN, adds, “Surgery day is my favorite day. The atmosphere in the OR is always upbeat. I love the positive energy”.

Making sense of LASIK technology

“Broad beam lasers ignited the entire refractive surgery revolution”, says James Lewis, MD, a Phoenixville 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 intefered 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.

© 1999, Patient Education Concepts, Inc.

“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”.

In addition to LASIK, Dr. Lewis offers an extensive array of other vision correction procedures. He is renowned as a talented Philly Epi-LASIK surgeon and one of the most highly experienced ICL Philadelphia specialists.