Volume I Issue 16

Originally published, April 22, 2001

LASIK Interviews on the World Wide Web

Photographs and interviews by Sue Cross

Using the computer to research LASIK

A growing number of patients are looking to the Internet to learn about LASIK.
The constant barrage of radio ads, junk mail, and limited time promotions for something as serious as laser eye surgery has left patients uneasy.
Recent corporate bankruptcies by presumably well-funded laser vision correction corporations have emphasized the need to research the qualifications, reputation, integrity, and experience of all LASIK providers.
“The world wide web was designed to disseminate information and share data,” explained James Lewis, MD, Medical Director of iHateMyGlasses.com.
Dr. Lewis has always been a strong proponent of the use of computers in medicine. Software he completed while a resident at Duke University Eye Center was used by Jefferson Medical College in Philadelphia to educate medical students for nearly two decades.
“I take a very active role in our web site. I upgrade it several times a week and don’t expect that behavior to change,” Lewis continued.
Lewis is particularly proud of the multimedia component of http://www.iHateMyGlasses.com. “Nothing is more vibrant than an unedited interview with a post-operative LASIK patient. Our LASIK coordinator, Sue Cross, is a highly-skilled communicator. ”
The patients shown above were the first to provide online testimonials about their surgical experience with Dr. Lewis.
Lewis doesn’t want to stop here. He is putting the finishing touches on http://www.lasikTV.com. It is an unedited weekly web cast of surgery as it happens. A prototype should be working when we go to press.
“We have been giving patients videotapes of their surgery since we started. LASIKTV is really nothing more than the extension of that concept. ”
Lewis feels prospective patients should be able to watch surgery, hear and read comments, and make an informed decision about LASIK within the confines of medical ethics and patient privacy.
“Too often construction of a web site is delegated to experts who don’t understand the surgery, haven’t talked to patients, and want to finish the job in a week or two. Most of my colleagues won’t even commit to communication with patients through email,” Lewis added.
Almost every LASIK provider has a web site. Most are generated from templates and have little real substance. Marketing companies have made a small fortune selling prefabricated web sites to LASIK surgeons who know they need to be on the net.
“LASIK patients are hungry for information about the procedure. They want to learn on their own time and in their own way. The glitzy web site with pretty pictures doesn’t impress them.”
Search engines can help. Unfortunately, clever programmers can get a mediocre site ranked well by outsmarting the search algorithms. One company deliberately submitted LASIK, LASiK, LaSIK, and lasiK to force a high ranking.
“Fortunately, patients are smarter than that. They want substance, knowledge, and inter-activity. At least 90% of the patients I see have visited our web site. This tells me are are moving in the right direction.”

Prototype fiber optic light pipe (courtesy Mastel, INC.) is used to verify corneal integrity during laser surgery by James Lewis, MD.

Volume I Issue 15

Originally published, April 15, 2001

Local Radiologist sees triplets after LASIK

Physicians become LASIK patients

Doctors are rumored to be the worst patients. Fortunately, when it comes to LASIK that doesn’t appear to be true.
Dr. Michael Miller (above), a radiologist at Lower Bucks Hospital, insisted that his eyes were very important to him. His entire livelihood depended on the clarity of his vision.
“Almost every LASIK patient tells me that,” explained Dr. Marc Myers of iHateMyGlassis.com. “We treat everyone and every eye as if it were sacred. Who do you know that doesn’t consider their vision precious?”
Dr. Miller also has other things precious. He is the father of four and is spending a day at home with his triplets.
Dr. Michael Matz (right), an Elkins Park Dentist, is experienced with office-based surgery. He was an outstanding patient. Several of his patients were so happy with the results of LASIK surgery at iHateMyGlassis.com he signed up.
Dr. Tim Smith (below, center), a Psychiatrist with the renown Friends Hospital in Philadelphia is not typical. He became a physician after his career as a champion skateboarder was cut short by an injury. Friends Hospital in Northeast Philadelphia is a division of the University of Pennsylvania.
Dr. David Zweiback (below left) referred his friend Dr. Smith. Zweiback was so happy with his LASIK results that he talked about the experience during a dinner together. A few weeks later his friend had an equally rewarding experience here.
“You know LASIK has become mainstream when the doctors become the patients,” claimed Dr. James Lewis, MD. “They know their career depends on a successful result and they have very carefully researched the procedure, the staff, and the surgeon.”
Physicians know there are risks and benefits to all interventions. A 99% success rate means one percent of patients have problems. iHateMyGlassis.com has taken considerable time to emphasize this fact. Dr. Lewis is particularly proud that his informed consent (permit) is ranked number one by nearly every top search engine on the Internet.
“We don’t want to worry patients unnecessarily, but we want to make sure they know this isn’t a haircut,” Lewis explains.
“There is probably no greater honor than being asked by a colleague to perform their LASIK,” Lewis continued.
Doctors do not have a monopoly. Many nurses, operating room technicians, emergency medical technicians, XRAY technologists, physical therapists, flight nurses, and others medical professionals have had LASIK.
Veterinarians are not strangers to laser vision correction or this office.

Area Doctors give up their glasses and contact lenses

Dr. David Zweiback (left), a busy Internist in Abington referred Dr. Tim Smith (right), a Psychiatrist at Friends Hospital in Philadelphia.

Michael Matz, DMD, had LASIK last year. He was working in his Elkins Park dental practice soon after surgery.

Volume I Issue 14

Originally published, April 8, 2001

Dry Eye and LASIK

James Lewis, MD, evaluates the ocular health following LASIK surgery in Philadelphia.

The tear film takes center stage

Dry eye, also called keratoconjunctivitis sicca, is a well established ophthalmic condition. Its role in LASIK has become clear as more, and more patients experience this exciting procedure.
Patients who have progressive difficulty tolerating their contact lenses may have dry eye. This can be the cause of their inability to wear lenses. Intolerance often results from decreased tear production (hormonal changes, aging, corneal anesthesia from prolonged lens wear) or lid margin disease (poor tear quality). Because dry eye motivates patients to have LASIK it is not surprising these symptoms may continue post-operatively.
James Lewis, MD, a subspecialist in Cornea and External Disease, explains, “The quality and quantity of tears must be evaluated and enhanced before and after LASIK. Failure to address dry eye can result in a less than satisfactory result.”
LASIK is somewhat traumatic even in the most skilled hands. When the microkeratome is applied patients can suffer damage to their goblet cells. These cells are vital to a healthy tear film. Flap creation temporarily severs corneal nerves and reduces corneal sensitivity. This interferes with the feedback mechanism and tear production. Toxicity from pre-operative and post-operative antibiotics, steroids and their associate preservatives can influence corneal health.
“Long term contact lenses stress ocular health. LASIK is also not without its problems. Maintaining the tear film is our most important post-operative task,” Lewis added.
Non-preserved tears have been vital in the treatment of dry eye. Usually, these compounds come in small, single use, plastic containers. Most recently, pharmaceutical companies have added nutrients including electrolytes to rejuvenate the conjunctival goblet cells.
Most artificial tears contain methylcelluose, and a pH balanced system to supplement one’s natural tear production. The post-LASIK cornea must have a smooth, lubricated surface to function adequately and heal normally.
Patients have found the single dose tears to be burdensome. Several manufacturers have added sodium perborate as a “benign preservative.” This allows patients to carry a convenient bottle of tears without suffering the consequences of standard preservatives.
“Treatment of lid diseases like rosacea and blepharitis can dramatically influence the post-operative course of our LASIK patients,” Lewis continued. This often includes pre-LASIK warm compresses, lid-scrubs, and antibiotic ointments. In rare occasions Ophthalmologists will initiate a course of oral Tetracycline to enhance the quality of the tear film before surgery.
Temporary collagen based punctal plugs have become an important weapon against dry eye. The plugs block the rapid exit of tears. A patient’s residual tear film stays in the eye longer. The cornea stays lubricated.
Permanent punctal plugs have been available for a decade. They are silicone and last indefinitely. Collagen plugs only last one to two weeks.
Oasis, of Glendora, California has designed an extended action punctal plug. Because LASIK patients need temporary help permanent, silicone plugs may not be ideal. Temporary collagen plugs don’t last long enough.
The Collagen-ED has been designed to function between one and four months. This is exactly the duration required by most LASIK patients. These plugs are in clinical trials.
“I am honored to be one of the Clinical Investigators chosen by Oasis for the Collagen-ED. It may represent an important option for our LASIK patients,” Lewis explained.
The treatment of dry eye in LASIK may lead to benefits for patients with severe rheumatologic disease and other immunologic disorders. In this group dry eye can represent a sight-threatening disorder. Fortunately, LASIK induced dry eye, when well managed, is usually little more than an inconvenience.

Lid margins must be free from debris and bacterial growth to insure an optimal LASIK outcome. Tear film quality depends on a healthy lid.

Happy Faces

Kevin Thompson keeps smiling despite the Eye News typo!

Volume I Issue 13

Originally published, April 1, 2001

LASIK after Dark: How to reduce glare

Glare is an important consideration for LASIK patients and LASIK surgeons. Early complaints of halos or difficulty with night driving have inspired refinements in laser technique. Measurement of pupil diameter in a dark room is now part of the standard LASIK evaluation.

An ideal ablation zone is larger than the diameter of the pupil. This reduces the chance of glare and halos.

Producing an ablative zone (lasered area) larger than the pupil diameter should reduce these symptoms. All light rays enter the eye focused, so no halos are produced. Initially, excimer lasers could only produce ablative zones between 4.5 and 6.0 millimeters. Because most pupils dilate from 5 to 9 millimeters in darkness, it is not surprising early laser vision correction patients experienced glare.
Virtually all popular excimer laser manufacturers have upgraded their systems. Patients with large pupils still represent a challenge to the LASIK surgeon. “You can’t simply continue to increase the size of the ablative zone. You will sacrifice too much corneal tissue and risk ectasia [weakening and bulging of the cornea],” explained Dr. Lewis.
Jose Barraquer, MD, of Bogota Columbia, the grandfather of LASIK suggested that 250 microns of untreated cornea remain after surgery. Ultrasonic pachymetry measures each patient’s corneal thickness prior to surgery. Measurements range from 420 microns to 600 microns.
“We routinely calculate the residual cornea before any LASIK procedure. Enhancements are no exception. We must temper our desire to minimize glare with our need to leave the patient with a strong and healthy cornea,” Lewis continued.
LASIK surgeons today divide the ablative zone into an inner optical zone and a surrounding transition zone. The optical zone corrects the patient’s vision. The transition zone removes less tissue and smooths the area between the optical zone and the untouched peripheral cornea.
Lewis claims, “One of the truly wonderful advantages of our Nidek laser is its ability to tailor the optical zone and the transition zone for each patient. I can consider pupil size, refractive error, and corneal thickness and select the ideal ablation pattern.”
Another advantage of separate optic and transition zones is the reduction of regression. The corneal contour is gently curved. The body tolerates this shape and exhibits little or no tissue response. Enhancement rates are significantly reduced.
Laser manufacturers have helped by improving their alignment and aiming systems. The attached surgical microscope helps the doctor position the laser.
“The fiber optic light source and the fixation capabilities of our system make me confident. I know the laser energy will go exactly where it should,” commented Lewis.
Medicine and industry continue to improve LASIK. 20/20 acuity is no longer the gold standard. Patients want excellent vision in all lighting conditions.

Happy Faces

Karen and David Thompson relax for a photo during one of their post-operative LASIK visits.

Volume I Issue 12

Originally published, March 25, 2001

“Best of Philly” has LASIK

This year’s winner of Philadelphia Magazine’s “Best of Philly Teahouse”, Grace Chen of Ray’s Cafe has successful LASIK surgery by Dr. James Lewis.

PHILADELPHIA, PENNSYLVANIA _ When Dr. Lewis lived in Center City he was a frequent patron of Ray’s Cafe. Many considered it the best cafe in the city.
In the last decade Philadelphia Magazine recognized Grace Chen (owner of Ray’s Cafe) four times as the “Best of Philly Coffee”. She won again this year for her selection of exotic and vintage tea.
“I was honored when Grace asked me to perform her LASIK surgery”, Lewis explained. “Her extended work schedule did not make her the ideal contact lens patient.
During her evaluation Dr. Lewis found that Ms. Chen had 14 diopters of nearsightedness. This is three to four times the amount present in most LASIK patients.
“There is a limit to what excimer laser refractive surgery can accomplish safely. I decided to operate conservatively and preserve her corneal health”, Lewis continued. “We both knew an enhancement could be used to refine the results.”
Enhancement surgery is nothing more than additional laser energy applied to the patient’s cornea to optimize visual acuity. Patients with high degrees of nearsightedness and astigmatism are more likely to need this fine-tuning.
“LASIK surgeons are foolish to boast of their low enhancement rates. They either don’t care what their patients need or they don’t know how to take advantage of this excellent tool”, Lewis commented.
Grace Chen needed an enhancement. While her glasses shrunk from 14 to 2 diopters she still couldn’t drive safely without them. Her enhancement surgery took a few minutes. She was back at the Ray’s Cafe with 20/20 vision the next morning.
“I am now learning the subtleties of Oolong and Green Tea. This is one of the great perks of this job”, Lewis said.
Despite the accuracy of laser vision correction, patients heal differently. Patients requiring an enhancement are not surgical failures. They are individuals who can achieve outstanding results with skilled application of this highly sophisticated technology.

Gourmet Coffee and Tea Aficionado refers world-class Fine French Pastry Chef for LASIK Surgery

Pascal Adelmar, Chef and Founder of Au Fin Palais winner of “Best of Philly Pastry” is on our LASIK schedule.

Mr. Chen oversees the incredible assortment of Fine French Pastries at Au Fin Palais following its recent alliance with Ray’s cafe.