Volume II Issue 5

Originally published, Sunday, March 18, 2001

Patients in Guatemala welcome your donated glasses

Citizens from remote villages in Guatemala wait as over 30 local eye doctors administer care. Volunteers distribute glasses, eye drops, and medical supplies.

Annual eye care mission visits Guatemala

PETEN, GUATEMALA_ Dr. Marc Myers returned to Central America to render eye care to impoverished villagers. This has become an annual event for Myers and thirty other local eye doctors.
Nearly 2000 patients from the remote towns of Los Cruses and Palestinia were examined and treated. This included scheduling over 100 cataract surgeries. Cataract blindness is a major cause of visual loss in many third world countries.
Wills Eye Surgical Network and several local industries donated much needed medications and supplies to this humanitarian effort.
Dr. Myers and the other volunteer physicians required an array of immunizations and other prophylactic medications before entering these remote regions. Despite the beauty of this environment considerable health hazards threaten visitors as well as the general population.
“This year”, Dr. Myers explained, “I brought hundreds of spectacles donated by our LASIK patients. I don’t know who was happier; the LASIK patients contributing their old glasses or the villagers receiving them. I am glad Advanced Laser Vision allowed me to continue my participation in this rewarding event.”
Dr. Lewis, Medical Director of Advanced Laser Vision said, “In our effort to continually refine our patient’s medical and surgical experience we can easily forget that some don’t have the basics. It doesn’t take much to pass good will along.”
Wills Eye of North East Philadelphia, a member of the Wills Eye Surgical Network, provided eye drops and surgical equipment for this cause. “Unopened eye drops which have recently expired have no value in this country but can save sight abroad”, Lewis continued.
The conditions in Guatemala are severe. The volunteers had to work in clinics without many of the technology and materials American doctors expect. Nevertheless, at the end of the week most of the villagers had their eye conditions treated. They were thrilled to be wearing “new glasses” and seeing their world more clearly.

Three young girls await their first eye examination by area physicians.

Gifts from local patients and area hospitals find a new home in Central America

Dr. Marc Myers refracts a young Guatemalan boy and dispenses the ideal pair of donated glasses.

Volume II Issue 4

Originally published, Sunday, March 11, 2001

Laser Clean Room eliminates contaminants during surgery

ULPA filters in Mastel’s Laser Clean Room remove dangerous compounds and microbial agents released during LASIK. The patient, staff, and surgeon are protected.

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 has 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.”

Laser plume evacuator handle with attached fiber

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.

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

© Copyright Moria, INC.

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.

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”.

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.