Essentially, a cataract is a clouding of the natural lens in the eye. Though often described as a film or coating over the eye or the vision, the abnormality lies inside the eye. (See the pictures below.)

There are many different types of cataracts, but the most common, and the type most people are familiar with is the senile, or age-related cataract – often described as nuclear sclerosis, a generalized clouding of the lens. Other types that may occur alone or in conjunction with the senile cataract are posterior subcapsular, cortical, anterior polar, etc. They may be classified as immature, mature, hypermature, congenital, traumatic etc. But essentially, if a person lives long enough, they will develop cataracts.

A cataract can interfere with the vision in a variety of ways. Most often, the vision becomes slightly fuzzy or blurred with a loss of visual acuity (eye chart vision) – but since this usually happens slowly over many years the individual may not notice until late in the development of the cataract. Sometimes the patient experiences a lot of glare or a halo around lights, often becoming so bad as to make driving difficult, especially at night. Contrast sensitivity is also lost, so that contours, shadows and color vision are less vivid. A ‘browning or yellowing’ of the vision is a sign of cataracts.

Causes of cataract formation are many. Long-term exposure to ultraviolet light and radiation is a significant cause. Diseases such as diabetes or hypertension play a role as does any trauma to the lens or long term use of corticosteroids. Genetic factors also play a role.

As discussed previously, there is no tried and true way of preventing cataracts. The wearing of UV blocking sunglasses may slow the development of them. Regular intake of antioxidants through one’s diet may help prevent or delay cataracts (but supplements have shown no real benefit in this respect).

Treatment of cataracts ultimately means surgery. Compared to years ago when surgery would take an hour and a person was in the hospital for up to a week, today’s cataract surgery is revolutionary. It is performed on an outpatient basis with local anaesthesia and usually takes less than half an hour. Before, a person was restricted to the use of very thick glasses after cataract surgery for normal vision, but today with the latest intraocular lens implants, a person’s vision is usually very good starting soon after the procedure and without the need for glasses. New multifocal or accommodating intraocular lens implants may even afford the post-cataract surgery patient good vision both at near and at far.

Lasik Crossword Puzzle Update:

Congratulations goes to past patient Jackie Gauci from Michigan who was the first to successfully answer the crossword puzzle in last month’s newsletter. She opted for a $250 gift certificate.

Answers to Last Month’s Lasik Crossword

The theme for July is ‘Wellness and Health Naturally’, and so Gotham is providing some information and a few helpful hints for increasing your holistic health awareness and hopefully by doing so, improving your life and health. I refer you to my previous post in the March newsletter Doctor’s Note on nutrition and eye health. Below you will find some info to help with your skin and skincare routine. I would like to just mention something about blueberries since summer is upon us. Lutein and zeaxanthin are carotenoids found in blueberries. Both of these carotenoids show promise in slowing age-related vision disorders and eye disease. According to Jules A. Mares, PhD, et. al., in an article published in the Archives of Ophthalmology, lutein and zeaxanthin may even slow progression of disease once the disease is present, but I must stress that studies so far are inconclusive. In fact, eating at least three servings of any fruit per day may help prevent age related macular degeneration, not necessarily just blueberries. So at this time of year when fruit is so readily available and so fresh, it only makes sense to add it to your diet – it doesn’t hurt, it’s good for you, and it may help your eye health!

Crossword Puzzle!

This month I’ve included a crossword puzzle whose topic is the eye, lasik, and laser vision correction. The first person to finish the puzzle correctly will receive a prize. (Next month will be a puzzle for skincare.) All answers can be either emailed to me at: drbonanni@gothamlasik.com, sent by mail (postmark date) to our address: 156 West 56th St., 12th Flr, NY, NY 10019, or faxed to: 212.646.9998 Good luck!

This month brings exciting times to Gotham. It is my pleasure to announce that Gotham Lasik is the first center in NYC to bring you Z-Lasik, the latest advancement in laser vision correction. This advancement ushers in the next era of bladeless, all-laser LASIK. The Allegretto laser is now paired with the Ziemer LDV femtosecond laser to provide a superior and safer creation of a lasik flap and treatment. The accuracy, safety, and comfort are all improved with this technique. Z-Lasik also allows treatment of a greater percentage of patients, often allowing people with thinner corneas or very large corrections to now enjoy the benefits of lasik – quicker healing with unsurpassed visual results.

The Ziemer LDV femto laser is an advance over the Intralase laser which was one of the early femtolasers available in the USA. By using significantly less energy and by operating at a faster rate than the Intralase, many of the disadvantages of the Intralase have been avoided. The time the laser is in contact with the eye is reduced to a minimum and is both comfortable and painless. Most importantly, the inflammation that often accompanied the Intralase is no longer seen – the Ziemer operates at one hundredth the power of the Intralase and its pulse rate is only one quadrillionth of a second. The recovery and visual results are quicker after the procedure.

With Z Lasik™ you now have the assurance of knowing that the first step in LASIK eye surgery is safer and more accurate than ever before, further ensuring the best LASIK results possible. Of course everyone still gets the Allegretto laser to reshape the cornea and correct the vision –the only laser to retain the natural shape of the cornea giving better vision and reducing the side effects of glare, haloes, and night vision problems. Z-LASIK enables Dr. Bonanni to create a large flap, keeping it in line with the large treatment zone of the Allegretto. This also reduces the risk of undesirable side effects such as dry eyes, deteriorated night vision and glare.

To learn more about Z-Lasik check out our website gothamlasik.com – or give me a call or come into the office for more information.

Thanks,

Brian A. Bonanni, M.D.

Match the eye anatomy with the function description.

Send your answers in to appointments@gothamlasik.com and enter to win a special gift!

Doctor’s Note

In honor of national nutrition month, I thought it would be appropriate to highlight the importance of certain foods and supplements in the maintenance of good vision. It should be stressed that nutrients are best obtained through the diet and not through supplements. For certain people or disease states however, the only way to properly obtain adequate levels of vitamins and nutrients is through supplementation; and the marketplace certainly provides an abundance of products to suit almost anyone’s needs (and if not needs, then their wants).

Ideally one’s diet should have plentiful quantities of intensely colored fruits and vegetables. Dark leafy greens such as kale, collards, bok choy; carrots, squash; tomatoes and mangoes, all should be included in the daily diet. All these foods contain lutein, a carotenoid. It has been shown to protect against two age-related eye disorders – macular degeneration and cataracts. The yellow pigment in the retina (back of the eye) is made of lutein and another carotenoid, zeaxanthin. This ‘Macular Pigment’ absorbs blue light, a harmful spectrum of sunlight that results in photo-oxidative damage. (Zeaxanthin can be found in bell peppers, oranges, corn and honeydew melons. Some research indicates that at least 6 – 10 mg of lutein be included in the diet daily. (The average American only consumes about 1-2 mg.) An added bonus to taking in lutein is that it may protect against clogging of the arteries.

The AREDS study (Age Related Eye Disease Study) found that taking high levels of antioxidants and zinc can reduce the risk of developing advanced age-related macular degeneration (AMD) by about 25 percent. The high levels used in this study are hard to obtain by diet alone, although diets high in green leafy vegetables and fruits do play a role in reducing the incidence of macular degeneration. Also, a daily specific daily amounts of antioxidants and zinc used by the study researchers were 500 milligrams of vitamin C; 400 International Units of vitamin E; 15 milligrams of beta-carotene (often labeled as equivalent to 25,000 International Units of vitamin A); 80 milligrams of zinc as zinc oxide; and two milligrams of copper as cupric oxide. Copper was added to the AREDS formulations containing zinc to prevent copper deficiency anemia, a condition associated with high levels of zinc intake.

There are numerous eye vitamins available that take their specific quantities and ingredients from the AREDS study. A word of caution to smokers – ingestion of beta-carotene in the AREDS study was linked with an increase in lung cancer incidence. There are now eye vitamins based on the AREDS study without the beta carotene formulated just for people who smoke.

Flaxseed oil and fish oil, alone or in combination, has been shown to improve signs and symptoms of dry eye. Flaxseed oil contains high levels of an omega-3 called alpha-linolenic acid (ALA). During digestion, ALA is converted into two different omega-3 fatty acids — called EPA and DHA. Fish oil contains EPA and DHA omega-3s in their natural form. Therefore, your body doesn’t have to break down ALA into these more readily-used forms, as in the case of flaxseed oil. Some supplements contain both fish and flaxseed oil (Thera Tears Nutrition). Any fish oil supplements should be mercury-free and the eating of fish should be limited to two or three times a week to reduce the risks of ingesting contaminants.

Bilberry is often touted as having a beneficial effect on the eyes. It is claimed that it prevents or cures cataracts, macular degeneration, glaucoma and night blindness. However, none of these assertions are proven and a lot of further good research needs to be done.

So, to sum it all up, do as your mother probably told you, eat healthy and the benefits will follow.

For a limited time, Gotham Lasik Vision is discounting custom lasik procedures for groups of 2 or more! Contact Ahmad Sahar, our Managing Director for additional information and guidelines. ahmad@gothamlasik.com or at 212-581-1280.

Doctor’s Note

Welcome to another issue of our newsletter. It is February where the cold of winter is fully upon us with all that that entails in respect to our eyes and bodies. The name February comes to us from the latin Februum, meaning purification, from the purification ritual Februa held Feb. 15th in the old Roman calendar. It seems appropriate then at this time of year when our thoughts turn to improving ourselves and making ready for the rebirth that is spring, that an assessment and checkup of our present physical condition should be undertaken.

Of paramount importance is the annual eye exam. For many, this simply includes a check of the vision and a prescription if one wears glasses or contact lenses. This is not a complete eye exam and a disservice is done if that is all that is performed. An eye exam should consist of a full exam of both the front (e.g. eyelids, conjunctiva, cornea, iris, lens) and the back (viteous, retina, optic nerve) of the eye. In addition the muscles and nerves of the eye should be checked for any problems with movement, focusing, double vision, etc.. Intraocular pressure and visual fields should be assessed for signs of glaucoma (a common disease usually with no symptoms that can lead to blindness). Cataracts, macular degeneration, infections and inflammation of the eye need to be checked for before serious blindness ensues. The thousands of diseases that can effect the eye are often symptomless with the person unaware until the disease has progressed far along.

The importance of such a complete eye exam cannot be overstated. Systemic diseases such as high blood pressure, diabetes, thyroid disease, cancers, nerve palsies, to name but a few, can be picked up. Problems with the lungs, kidneys, brain, skin, liver, intestines, heart, etc can often be seen, diagnosed and then be treated. So, besides localized eye diseases and conditions, an eye exam can often be the first indication of a more widespread condition and so can often aid in early diagnosis and prompt treatment.

So, if February can teach us anything, it should be a month in which we evaluate our bodies and ready them for spring’s renewal. And as the month of love, it should be a time where we think of our loved ones and ensure they also get checked – it will show just how much you care.

Eye Health Assessment

What better way to say “I love you” to those closest to you then with the gift of perfect vision? Gotham Lasik Vision can provide your loved ones the opportunity to rid themselves of glasses and contacts and achieve remarkable results with their custom lasik procedure. No heart shaped box of chocolates nor any amount of red roses can compare to the gift of perfect vision. Contact the Gotham Concierge today to arrange for a complimentary consultation and eye health assessment and give the gift that will be remembered for a lifetime!

Top 5 Ways Lasik is More Affordable Than Ever:

• Easy Application Process that takes just minutes to see if you qualify!
• Over 90% of our patients are eligible and qualify for financing.
• Finance your full procedure cost interest free for 18 months!
• We can custom tailor a program that fits your current budget.
• All our financing programs require ZERO down payment, making it more affordable than ever!

Contact us directly to see if you qualify. You can be scheduling your procedure within days and be rid of your glasses and contacts forever!

Doctor’s Note

At this time of year it is natural to look back and contemplate the significant events of the past year. And being the end of a decade I thought about how much laser vision correction has changed over the past ten years. Back in 2000, most were happy with getting 20/40 vision – the vision needed to pass the driver’s vision test and good enough to get around without glasses. Now, I think most people should be achieving vision of 20/20 or better. This is due not only to the advances in laser technology, but also the added experience and care of many surgeons.

The evolution of lasers over the past ten years has been profound. Early lasers had small optical zones (sometimes 5.0 mm). These zones were then enlarged and transition zones added to smooth the edges of the treatment. This decreased the rate of side effects. The broad beam lasers which sculpted the cornea in a rough manner were challenged by the scanning spot lasers which offered smoother and larger treatments – improving the quality of vision and again reducing side effects. Custom treatments which took into consideration other factors of the eye besides just the prescription also came about and should now be the norm.

It’s hard to imagine not measuring the thickness of the cornea or looking at its shape but many doctors early on did neither. Thinning of the cornea too much, especially in individuals with certain corneal conditions, led to problems – poor vision and often corneal transplants. Then, the pachymeter to measure thickness and the topographer to check the shape for corneal disease became common place – because it was found not everyone was a good candidate for surgery.

However, certain corneal conditions, especially in their early forms, were hard to diagnose and still sneaked through the screening process causing problems. Now we have instruments to visualize both the anterior and posterior surfaces of the cornea to better diagnose these conditions in their earliest forms – ideally preventing these patients from being operated on.

What the next ten years hold anyone can guess. With each new advance, we will be able to operate on more and more types of conditions – people that now can’t have surgery. And of course, perform the procedure more safely.

New Year, New You

Its a new year, a new decade! Pamper yourself with one of Gotham Skincare’s New Year New You Specials

Renew and Relax with a Gotham Glow Signature Facial and a 20 minute Massage for $150
Erase the stress and leave it behind, and get your Glow Back!

Refresh your appearance and begin the year with confidence! With the purchase of any one area of Botox, receive the second area 1/2 price & enjoy the results from your complimentary Rejuvinating Peel!

With both specials a Free Skincare and Makeup Consultation is included.

Happy New Year from Gotham Skincare, we look forward to helping you address all of your Skincare needs!

The Liquid Facelift: Look Your Best in 2010

There are many names for it, Facial Revolumization, the Non-Invasive Facelift, The Filler Facelift, and The Liquid Facelift. Dr. Bonanni has always known the power of facial fillers, neurotoxin and chemical peels and the dramatic effects that a combination of treatments can produce, however in 2010, Dr. Bonanni wants his patients and the public to know that one does not need to have invasive procedures to refine and sculpt the face and skin. From the list of treatments that can be combined to address your concerns, it is not the individual procedures that are the trend. The Liquid Facelift is the trend; the trend is to get the results you dream of without being invasive.

To address skin texture, tone, elasticity, fine lines, and overall complexion, a series of custom chemical peels are recommended to leave you with a flawless canvas for the artist. Dr. Bonanni will then discuss with his patient his or her concerns and makes decisions as to which of his palette of facial fillers he will choose from to best achieve the desired goals. He will choose from Juvaderm, Radiesse, Perlane, Sculptra, all which have optimal results when used by a skilled, experienced Physician such as Dr. Bonanni. The fillers can be used to create volume where it has been lost, for example in the cheeks or lips; it can also be layered with Dysport or Botox, to address deep wrinkles on the forehead or glabellar region. The fillers can also be used to fill extremely deep acne scars, or to define the jawline or the bridge of the nose. Botox or Dysport can be used to treat wrinkles on the upper region of the face, however it can also be used to turn up the tip of the nose, treat dimpling on the chin, it can even be injected on the sides of the jaw to soften the shape of the face and create a more oval shape.

To maintain the results of your liquid facelift, a common trend for skincare and 2010, will be to end the never ending hunt for skincare products that work, and actually produce results. The search will end with people throwing away the thousands of jars, bottles and creams that litter your bathroom shelves and, committing to using a medical skincare system that changes your skin on a cellular level. Dr. Bonanni and the Director Alexandra Plotkin of Gotham Skincare will consult with their patients to find the appropriate skincare protocol from Obagi Medical, their choice in Medical skincare lines.

Call 212.616.9995 to book your appointment.