Volume I Issue 26

Originally published, July 1, 2001

LASIK Grows in Popularity

Robert Marberger, RN, research coordinator at Cooper Medical Center Trauma Unit sits with James Lewis, MD. After his LASIK Robert said, “Thanks to a wonderful team.”

by James Lewis, MD

LASIK is an experience rather than a surgical event. It begins with your first call, and it should never end. You should be able to count on someone being at the end of the phone (or email) to answer brilliant questions as well as “stupid ones” for life.
Surgeons emphasize their experience, their great equipment, their safe environment, their high-powered references and their brand affiliation; these are prerequisites. Geniune concern for your total well-being (standard at iHateMyGlasses.com™) sets us apart. This is why we don’t have “levels” of service or “treatment plans” for our patients. Everyone’s eyesight is precious.
It took time to assemble a group of caring, motivated staff. Sue Cross, our LASIK coordinator can handle almost anything. Debbie Breig, our experienced scrub nurse and LASER technician has never been seen making a mistake or losing her cool. Michelle Nolan had LASIK and tells patients exactly what to expect and how to take care post-operatively.
We’ve set a maximum on the number of LASIK procedures we will perform in a day. We can’t provide enough attention to the surgical detail and your emotional needs if we try to do more. (No assembly lines here.)
Everyone is nervous about surgery. Everyone wants the best result. My staff insists I exercise regularly and stay healthy for surgery. They won’t tolerate a “second best” surgeon so you won’t either.
I am touched that Nancy and Brenda always stay late. They are there for you and never look at the clock. I am lucky to work with my closest friend Barry Fabriziani, OD in Phoenixville and Jenkintown. He is the best doctor I know. We affectionately call him “FAB”. We’ve started to call Marc Myers, OD, pre-FAB, because he has all the same traits except he doesn’t have grey hair. Dr. Myers splits his time between Mount Laurel and Jenkintown.
As a cornea subspecialist, it took time before I was comfortable operating on a medically-healthy eye. If the results hadn’t been outstanding and the patient experience emotionally rewarding, I would have stopped immediately.
LASIK is the most exciting advance in our field in years. Whether you visit us or another reputable provider, you should see whether LASIK makes sense for you.

More Area Residents are Discovering the Benefits of LASIK

Stephen Reed of Dresher studies audio engineering. He was happy with the caring and supportive staff and felt no pain.

Jeff Kochanowicz’s daughter plans to be an eye doctor. She watched her father’s LASIK very, very carefully.

Gary Coppola, Production Director of the Pottstown Mercury, says“everything is clear”.

Volume I Issue 25

Originally published, June 24, 2001

Is Summer a Good Time for LASIK Surgery?

Dr. Lewis and Dr. Myers discuss their submission to the FDA. This research uses LASIK to improve vision in patients who have had a corneal transplant.

photography by Sue Cross

Swimming without Glasses or Contacts Makes LASIK Popular in the Summer

by James Lewis, MD

LASIK patients want to know when they can resume their normal activities.
As surgeons, we want to be conservative but as realists we want patients to get back to their daily routine. Below are some general guidelines:
Driving is usually possible the morning after LASIK surgery. While night driving can be more variable, we need patients to exercise good judgment.
Swimming is usually restricted for two weeks. Recent discussions on Kera-Net (a chat line for Ophthalmologists) suggest that even less time may be required. Scuba diving, surfing, high diving, and waterskiing should be avoided for two weeks. Chlorine and saltwater are not a special concern.
Exercise can begin the next day. Effort should be made to reduce sweat in the eyes by using a headband or a hat.
Showers can be taken any time after surgery. It is best to keep your eyes closed gently for a few days while showering.
Golf is a special case. We ask golfers to wait at least eight hours before getting back onto the green. You can use your surgery as an excuse for a bad game for at least six to twelve months.
Alcohol use is not restricted after the first twenty-four hours. Smoky environments (bars, concerts, parties) may require an extra dose of the non-preserved tears. They can be found in your post-operative kits. Sometimes your eyes will be tired. Go home.
Commercial airline travel is fine after you are seen the day following surgery. Because the plane’s atmosphere is extremely dry, you may need to use a lubricating gel and close your eyes on longer trips.
Makeup is not my area of expertise. Nor are questions like “when is it OK to have my hair done?” I recommend waiting about a week. Make sure nothing touches the eye (eyeliner) and no powders, cremes, ointments, lotions, fumes, etc. get into the eye for at least that long.
Allergies are rarely a problem for LASIK patients. The medications given control itching and can be used for an extended period if necessary. Rubbing the eye should be kept to a minimum, and a real good rub should be avoided for several months.
Little children are my biggest fear. Whether they belong to you or not, they have an uncanny ability to touch and wrinkle your LASIK flaps during the first 72 hours. It is best to keep children at arms length for at least that much time.
There is no need to avoid the sun or the beach. Sunglasses should be used to protect your eye from the sun, sand and wind. I ask all patients to make sunglasses a regular part of their gear. Studies have shown a reduction in retinal disease and cataract development with sun protection regardless of LASIK. Of course, sunscreen is not an eye drop.
Sleeping immediately after LASIK is a required activity. We apply protectors for the eyes after surgery to prevent trauma (rubbing). Night shields (in your kit) are also advisable for several additional days.
Skydiving, extreme mountain climbing, and contact sports are best delayed for a month. There is no better substitute than good judgment.
Computer use and reading can begin soon after surgery. Remember, take frequent breaks and use non-preserved lubricants. If you feel as if you’ve had enough, you probably have!

Vince Shields, owner of Kenny’s in Southampton says farewell to Sue Cross, head LASIK coordinator.

LASIK Prices Revealed

Q: How can one doctor charge $5000.00 for LASIK and another charge $499.00?
A: Some doctors rent lasers. They are not committed to LASIK surgery. They don’t invest because they want to minimize their financial risk. Companies lease lasers to doctors and charge over one thousand dollars for each patient treated. Theses companies get 20 to 25% of your surgical fee.
Some doctors own their own laser but still charge too much! They are not better surgeons. They do not represent higher quality.
Others groups charge so little they have to run their office like an assembly line.
Q: Am I safer going to a University setting, a large corporation, or what?
A: No. An established physician is your best choice. Pick someone with a commitment to the community and an excellent reputation. They will be there for you tomorrow.
ihateMyglasses.com has never changed its price ($2500 for both eyes) nor its mission. We provide excellent care, top quality equipment, and a professional environment. We don’t overcharge, and we don’t run a LASIK factory.

Officer Mark Dietrich of Berks County found LASIK surgery simpler than expected.

Volume I Issue 24

Originally published, June 17, 2001

What do you really know about your LASIK surgeon?

Adolfo Rivera and James Lewis, MD immediately before LASIK surgery. Mr. Rivera’s daughter (see inset) had successful LASIK by Dr. Lewis months ago.

photography by Sue Cross

The single most important element in your LASIK operation is your surgeon !

Guest Editorial
Jose C. Amram, BSEE

I met James Lewis, MD, nearly two years ago. My background is engineering and I’ve spent nearly a decade maintaining excimer lasers throughout South America and the United States. I am proud to have worked for Lambda-Physik, Nidek, Icon, and Lasersight.
Nidek sent me to perform routine maintenance on his laser. Lewis spent hours observing me clean, adjust, calibrate, and tune the device. He was full of questions. This is unusual. Surgeons usually ask me to turn off the light when I’m finished fixing their machine.
The next day I stayed and watched Lewis operate. I have been in hundreds of operating rooms and have seen thousands of LASIK procedures. I was impressed. I suspect that is the reason I asked him to perform my LASIK surgery.
I am happy to report a terrific result. I see 20/20 in the left eye and an outrageous 20/10 in the right. Dr. Lewis knew my job required virtually a perfect result. He did not let me down.
I live in Florida and routinely fly from one operating room to another. I was in the ideal position to pick my LASIK surgeon. Results were more important to me than convenience.
Lewis will not compromise on care. He is always trying to refine the procedure, improve his technique, or upgrade his equipment. He is passionate about the surgery and maintains operating suites that rival any I have seen. His staff is professional and compassionate. And I know I wasn’t treated any differently than the next guy.
I’ve described Dr. Lewis as one of the last remaining intellectuals in LASIK. He studied mathematics at Princeton. He uses his computer expertise to improve the nomograms that configure the laser. He wrote the software that gave me my visual results. I think that proves my point.
Lewis trained at Jefferson Medical College and was an Ophthalmology resident at Duke University Eye Center. He did a corneal fellowship in Adelaide, South Australia. He ran the Cornea division of Hahnemann University for three years before going into private practice.
Very few of the surgeons I visit still contribute to the science of LASIK. Lewis is involved in Level 1 FDA-studies and what I suspect will be ground-breaking work on astigmatism for corneal transplant patients.
Finally, Lewis, does more than LASIK surgery. He has one of the largest cataract, implant, and transplant practices in the region. Lewis works exclusively at Wills Eye for these procedures. He has been one of the top surgeons at Wills Eye for years.
I have been behind the scenes in large LASIK practices, fancy Universities, and giant corporate centers. I have worked with doctors with large reputations (and even larger egos).
I picked the best place for LASIK. I picked Dr. James Lewis.

Debbie Breig, head LASIK surgery technician helps Dr. Lewis plan laser settings.

Dr. Lewis checks the post-operative appearance of his LASIK patient.

Volume I Issue 23

Originally published, June 10, 2001

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.

Volume I Issue 22

Originally published, June 3, 2001

In LASIK, do you really get what you pay for?

EDITORIAL by
James S. Lewis, MD

“There is nothing mysterious about LASIK surgery. It is a very precise and elegant procedure,” claims James Lewis, MD, Medical Director of iHateMyGlasses.com. Patients and their families are eager to learn all the details.
Despite concerns by malpractice insurance carriers, Dr. Lewis feels every patient is entitled to a record of their surgical experience. All patients leave the operating room with a videotape.
“Friends, co-workers, and family members are usually very excited to watch the procedure. Some start reluctantly viewing the 42 inch plasma-based flat screen monitor that hangs outside the operating room. By the end of the case they are totally absorbed,” Lewis claims.
Dr. Lewis leaves the OR between patients to answer questions. Many are curious about the temporary colorful marks made on the cornea which helps align the tissue at the end of the case. Observers learn that the same fluid pump that keeps the cornea clear (the endothelium) holds the flap in position after LASIK.
The biggest surprise to those who watch the surgery is the gentle nature of the excimer laser. It appears as a flashing blue light that gently sculpts a precise amount of corneal tissue. A fair number of viewers will say, “This isn’t too bad. I think I will get a LASIK evaluation.”
Patient privacy and the protection of medical information have always been an important considerations for iHateMyGlasses.com. All patients are asked for their consent before any surgical footage is displayed on the screen or used in the webcast. Dr. Lewis is proud that most search engines rank his video and photographic consent near the top. This is important even when no identifying marks are present.
LASIKTV is based on a Linux video server created by Videocomplex in Vancouver, Canada. It provides the best quality video for viewers with high speed connections.
Dr. Lewis is working with another company, NuSpectra Multimedia, Inc. of Alameda, California. They will improve the viewing experience for patients with slower connections (33 or 56K modems). The NuSpectra system will allow users to control the camera and look around the operating suite.
Another exciting advantage of the NuSpectra System, called SiteCam, is the ability to archive images. Patients will be able to tell their friends to log on and view their surgery at their convenience. Lewis is working to make certain there are password or passphrase controls to adequately address medical privacy concerns.
When the LASIKTV project is complete individuals will have a number of ways to view, archive, and even distribute their own surgical videos.
A startup internet company designed to educate ophthalmic surgeons throughout the world was just launched by John Wolfe, former CEO of Staar Surgical, INC. This company, Broadcastsurgery.com, was based, to some extent, on talks Dr. Lewis and Dr. Alan Shelton (Santa Monica, CA) had with Mr. Wolfe during the last three years. “Mr. Wolfe has always stayed ahead of the curve. His emphasis on education and international physician to physician interaction should make this venture a great success.”
Dr. Lewis has been asked to serve on the advisory board of this new webcasting company.
One of the aspects of LASIKTV that makes it special is its lack of editing. All surgeries are seen without modification. Prospective patients experience LASIK that isn’t “sugar-coated.” They also can remain anonymous and consider the surgery without making an intellectual or emotional commitment.
“Of course, there are always a handful of patients who don’t want to see the surgery before or even after their procedure,” Lewis admitted. “There is an off switch.”

No glasses for Howard Gribben as he schedules his one week post-operative LASIK followup. We liked his golf joke!

Stephanie is told by Dr. Fabriziani her mom can see 20/20 in her right eye and 20/25- in her left one week after LASIK.