Surgeons embrace LASIK

Sharon Josloff sits with her husband after LASIK. Dr. Josloff said he saw well enough to operate 24 hours after surgery. As a patient he realized how important it was to be relaxed during the procedure. “ Your staff is the best.”

Abington General and Laparoscopic Surgeon ends his dependence on glasses and contact lenses

GUEST EDITORIAL
by a Philadelphia Medical Malpractice Attorney and LASIK patient

I sit here writing my thoughts about a month after having had LASIK surgery with Dr. James Lewis. No doubt, I was not Dr. Lewis’ “typical” patient. My educational background is in the legal and medical fields and has made me an educated consumer – – and a skeptic.
It took me about three years to garner the resolve to actively seek out surgery to correct my vision. Starting with 20/200(R) – 20/400(L) vision with correction to nearly 20/20 with glasses or contacts, I was motivated to be able to see better without the nuisance of glasses or contacts. In my line of work (medical malpractice), I knew too well what the horrible possibilities were and was hesitant to invite them to my door. A sense of humor is integral in my life and I didn’t want to lose mine as a result of this surgery.
After doing a fair amount of Internet research about LASIK surgery, lasers, various centers, multiple surgeons, risks of the procedure and news/opinion articles, I pored over the various web sites of many of the LASIK centers. Dr. Lewis was an unknown to me (in my line of work) before my surgery. One could say that that, in itself, was a good thing, given what I do for a living. Gathering information and references about the practice and person who would ultimately do my surgery was a priority. I had to be comfortable with not only my surgeon, but also the office staff and support personnel. Meeting my potential surgeon would be the deal maker or deal breaker.
When I started my active search for a LASIK surgeon, I was cautious and completely willing to forego surgery until and unless I found a good “match.” Glasses or contacts were not the worst burden in the grand scheme of things. My calls for preliminary information (after gathering a fair knowledge base from my research) to a number of LASIK centers were met with anything from cool indifference to unsupported and outrageous “guarantees.” Curiously, some centers I called would not discuss the type of laser they utilized. Two centers refused to tell me whether residents (doctors in training) would be responsible for performing any or all of the surgery. It wasn’t difficult to weed out some of the centers (and potential surgeons) merely based on these initial screening calls. After I called many and met with three other practices and discussed the possibility of LASIK surgery, I appeared at Dr. Lewis’ door.
As fate would have it, I was, by my own error, late and somewhat flustered upon arrival. Michelle, Dr. Lewis’ very skilled and efficient LASIK Coordinator, was gracious and understanding of my late arrival (even though I was the last appointment of the day). The initial evaluation and information gathering started immediately. I was provided with a packet that contained information about LASIK surgery generally and the specific laser Dr. Lewis uses. Overall, it was a wealth of information that pre-operative patients should know or at least be curious about. The twenty-one page consent was enough to make any potential patient think more than twice about making the leap.
The initial appointment started with a history form and a series of evaluations and examinations. It was then that I was introduced to Dr. Marc Myers who continued the evaluation and history gathering process. Dr. Myers, I learned, would be totally involved in my pre- operative and post-operative care. Dr. Myers confirmed, as I suspected, that I was a good candidate for this surgery. The ball was in my lap.
Neither Dr. Myers nor Michelle ever shied away from any of my rather pointed questions. Having all of my questions answered and continuing to gather additional information was paramount. I was not disappointed.
Based on my perception of the various LASIK centers to which I had been exposed, Dr. Lewis’ practice seemed to be the “well-oiled machine” I was seeking. From the operators answering the phones to the office staff, everyone seemed pleasant, efficient and knowledgeable. The missing component, at that point, was a personal meeting with Dr. Lewis. It was still early in the process and I had some more information-gathering to do before I could be sure I wanted this surgery or that I wanted Dr. Lewis to be my surgeon. Regardless of these hurdles, I scheduled my surgery for a month and a half later. I wouldn’t be shy about canceling the surgery if things weren’t right. Nothing about my vision or the surgeon who would be responsible for its correction required a rush to judgment. Not having met Dr. Lewis, I was still unsure if this was the perfect fit I needed.
I left Dr. Lewis’ center carrying the packet of information and the intimidating twenty-one page consent. After carefully reading the consent and the accompanying information, I found myself still interested in pursuing LASIK surgery. It very easily could have gone the other way. This decision is very personal and shouldn’t come as a result of others’ decisions. It is you who must live with the consequence of your decision.
As my possible surgery date drew near, I felt the ebb and flow of apprehension as I expected. Just to calm my concerns and to see if unexpected demands would be received as smoothly as the scheduled appointments, I stopped by at the office with no more than 10 minutes notice to ask some pre-op questions that cropped up with my reading of the consent. Michelle welcomed me in and invited me to sit down while she answered anything she could. She also offered to set up an appointment for me to speak with Dr. Myers or with Dr. Lewis to go over any and all concerns or questions. I was assured that I would have as much time as I wanted or needed to speak with Dr. Lewis either before or on the day of surgery. Michelle and I spoke for quite a while. Operative and post-operative surprises would not be acceptable. My questions were answered and I left very satisfied that this practice provided the comfortable fit I was seeking.
Dr. Lewis and I met on my day of surgery. Pre-operative medication was administered to allay any residual pre-operative angst and to foster the ability to rest comfortably after the surgery. I found Dr. Lewis to be a caring and warm individual who wasn’t a member of the “hard sell” school of practice. Our conversation was unhurried, friendly and included the all-important and necessary sense of humor. Although I had no unanswered questions, I asked Dr. Lewis certain of the questions that had warranted my impromptu visit days before surgery. He would, after all, be the one performing the procedure. A short walk later and I was being positioned for my procedure. I was comforted to see how careful and meticulous Dr. Lewis was to be sure the positioning was just right before beginning the procedure.
Even with my background, I didn’t really want to have a running color commentary during my procedure. Too much information would just keep me from remaining calm, cool and collected or benefitting from the pre-operative medication. A VHS video of the procedure could be made if I was inclined to see the surgery first hand. Dr. Lewis has a very warm and compassionate manner, while proceeding in a very professional and efficient way. Things progressed very nicely and in no time one eye was done. The other eye went just as smoothly. His assistants kept me aware of what generally was going on and were calming. Once the surgery was completed, medicated ointment was administered to both eyes and protective patches applied (shortly after I was pleased to look around the room and enjoy clear, focused vision without glasses).
I was driven to my home and rested for the balance of the day, as directed. The most unpleasant feature of my first day and night post-operatively was the tape holding the eye guards in place. That was a short-lived problem. Sleeping was no problem. There were no strange sensations, pains or problems with my eyes. Even through the medicated ointment and the eye guards, I could still see my alarm clock across the room. Not too shabby!
By the next morning, my 24 hour check up revealed uncorrected vision of 20/15. One week after my surgery, my vision had improved to 20/10. Due to my age and previous vision problems, I was pleasantly surprised that I didn’t yet need reading glasses. Close and distant vision are perfectly focused. This was neither expected, nor typical, from what I gather. I’m not complaining. I was careful to follow instructions to the letter. No swimming meant no swimming. Eye drops were instilled as directed. Absolutely no rubbing of the eyes. There are many instructions and following them was, to me, a priority.
At one month post-op, I continue to marvel daily at the crisp vision I have in both distance and close fields. While I understand that I’ll likely soon need reading glasses, I’m enjoying the temporary reprieve from all corrective lenses.
I make it a practice not to “recommend” physicians or procedures to others. What I do recommend is that you should be well informed and educated about the procedure and its risks and benefits and that you are comfortable with the health care provider you choose. These are big decisions. It’s not like buying an appliance on a recommendation. It should be given the appropriate measure of analysis that will make the health care consumer confident and comfortable. For me, this procedure and this surgeon were the right choice.

Meghan Fisher wears her mother’s “bunny suit” after Valerie’s LASIK surgery. Both proudly display their new iHateMyGlasses.com hats. Mrs. Fisher is a respiratory therapist at Pottstown Medical Center.

The Secret to Successful LASIK: Realistic Expectations

Michael D. Nicholas, MD, and his wife Cheryl hold their two week old son Rhys. Dr. Nicholas is a prominent member of PENNCare Central Bucks Pediatric Associates of Doylestown.
Barry Fabriziani, OD, evaluates Dr. Nicholas one day after LASIK

Do you really want perfect vision?

Patients ask me to aim for “20/20” or better yet, “20/15.” The entire industry is guilty of over-simplifying LASIK surgery.
Surgeons want their patients to see as clearly as possible. More important, they want patients to maintain excellent vision in both eyes for a lifetime. This is great when it happens on the first post-operative day. Surprisingly, some of my happiest patients have had enhancements because their vision didn’t reach our mutual goals and additional surgery was required.
LASIK is major ocular surgery. Initially fluctuations, dryness, and daily variations occur. Dr. Nicholas (see above) didn’t reach 20/20 on the first post-operative day. He knew his glasses were two to three times stronger than the average, and he expected his recovery to take more than a day. He understood biologic variation and anticipated these results. This knowledge has made him a very happy patient.
Overcorrection can occur when too much precious corneal tissue is removed. While this surgical approach can yield an early visual WOW, it jeopardizes the structural integrity of the eye and may lead to premature dependence on reading glasses.
Patients should be wary of doctors who boast their enhancement rate is extremely small. They are usually cavalier or just plain arrogant.
A conservative approach to LASIK produces a healthier eye and a patient with excellent vision.
Microkeratome technology continues to improve. Excimer laser technology is also improving. The body, however, is ruled by genetics, the environment, and more. Everyone is different, and we all heal uniquely.
You should expect an outstanding visual result from LASIK after a successful procedure. Sometimes this is immediate, in others it takes weeks or months. Sometimes a “tweak” or enhancement is appropriate. Occasionally an enhancement is foolhardy.
Our goal with LASIK is to make you dramatically less dependent on glasses. Most patients will eventually need reading glasses, and some will require spectacles for maximal acuity while driving at night or in rainy weather.
We don’t “set the laser for 20/20”; we aim to give you the most vision possible as safely as possible.
To be happy with your LASIK results means that you must respect your doctor, yourself, and nature. This is best achieved by doing your homework.
Learn about LASIK. Talk to your doctor. Make sure you want less dependence on glasses and not “perfect vision.”
We don’t want you perfect; we just want you happy and safe. Start with the right expectations.

Precision-Dynamics of Ontario, Canada delivers one of the first excimer laser profiling units for clinical use in the US.

Carolyn Pennypacker of Phoenixville brings Rusty to her post-operative visit. This magnificent miniature has a perfect disposition.

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.

Cataract Surgery at Wills Eye

Peter Giannopoulos, MD watches James Lewis, MD perform phaco-chop cataract surgery using topical anesthesia at Wills Eye Surgery Center in Plymouth Meeting.

Friends reunite 20 years later

PLYMOUTH MEETING, Pa. _ Victor Krzesinski, RN, director of Wills Eye Plymouth Meeting, welcomes Dr. Peter Giannopoulos at 7 AM to observe state-of-the-art cataract surgery.
Two years before, “Vic”, welcomed Dr. Lewis who began operating at the Wills facility soon after it opened.
Vic thought Dr. Lewis looked familiar. After surgery they remembered they had both worked in South Philadelphia at Methodist Hospital.
Lewis was still a Jefferson medical student and Vic was a staff nurse soon to rise to the top position in the operating room.
They recalled the Methodist cafeteria, the general surgeons, and other happy memories from twenty years ago.
“Once there was a medical student who paged a famous surgeon because that surgeon was late for a lecture! He caught serious grief!”. Jim Lewis was that medical student and didn’t know you weren’t allowed to do such things. “I am glad to see he hasn’t changed one bit”, Vic said.
“When I realized who Vic was, I felt like I had been working at Wills for decades. Vic treats everyone like they are special and as a result he has built an incredible surgical team”, Lewis said.
Patients report a feeling of warmth and professionalism when they visit Wills Plymouth Meeting. “There is no doubt, in my mind, that Vic sets the tone and everyone wants to follow. The surgeons and the community are fortunate to have access to very special people and a very special place”, Lewis said.

Dr. “G” (left) and Dr. Lewis (right) surround Victor Krzesinski, RN, director of nursing at the Wills Eye surgical facility

Wills Eye Equips Surgical Network for
Advanced Cataract Removal
Techniques

PHOENIXVILLE, Pa, _ American Ophthalmologists are praising the benefits of a new method of cataract removal developed in Japan.
Phaco-chop was launched when Dr. Kunihiro Nagahara won the 1993 ASCRS (American Society of Cataract and Refractive Surgeons) film festival with a video of this ingenious surgical maneuver. He used the same ophthalmic instrumentation found at the Wills Eye Surgical Network.
Phaco-chop uses the cataract’s own structure to help the doctor reduce zonular stress. It increases surgical efficiency.
Before this major advance cataract surgery required ultrasonic energy to excavate and then divide and conquer the cataract.
Phaco-chop needs as little as one second’s worth of energy. Earlier methods required several minutes.
Experienced surgeons have migrated to phaco-chop. They get excellent results and an improved safety profile.
Phaco-chop is ideal for advanced and mature cataracts. Large incisions, sutures, and astigmatism are a thing of the past.
Wills Eye in Plymouth Meeting recently purchased two Allergan Sovereign phaco units. They were designed specifically for Dr. Nagahara’s method.
“There is a learning curve to phaco-chop just like all kinds of eye surgery. It may take several months to master the maneuver”, said Dr. James Lewis of Phoenixville. Dr. Lewis has been performing phaco-chop for nearly two years. He expects more and more surgeons to start learning the technique. “It will make them wonder why they did it any other way.”.