When a patient is interested in the procedure only for the sake of improving their appearance, it is considered cosmetic. As you age the eyelid tends to stretch out, the muscles weaken and fat pockets accumulate underneath the eye. When these pockets accumulate fat tissue under the eye, it will appear to bulge out of the skin. Individuals seek out this procedure to improve the overall appearance of the face because droopy eyelids can make the face appear to be old or tired.

A functional blepharoplasty may be needed for medical reasons when loose skin from your upper eyelids droops and pushes your eyelid margin down into your line of sight. Other functional issues that may arise to require blepharoplasty are the inability or difficulty to wear glasses or contacts due to this issue, irritation from eyelid folds rubbing together, and discomfort in the forehead from overused muscles straining to lift droopy skin in the eyelid.

To find out whether or not you are a candidate for blepharoplasty it is important to schedule an appointment with your doctor to evaluate if this procedure is right for you and to see if it will improve your line of sight. If you are looking into blepharoplasty for cosmetic purposes it is important to take into account that while this procedure may greatly improve your appearance, the aging process will still continue and you may need to repeat the procedure in the future.

The overall system design and performance of the Allegretto Wave Eye-Q is a positive experience for both the surgeon and the patient. It operates using fast 400-Hz eye tracking and laser pulse rates. What does this mean exactly? This provides superb clinical results, improved patient comfort, and faster surgery time with more stable and accurate results. The Perfect Pulse Technology™ precisely controls each laser pulse and energy and its placement by video tracking to assure exact results. The Allegretto is the only laser system that actively controls the beam energy along its entire path from laser to eye to ensure stable, pulse-to-pulse treatment energy through the entire procedure.

The Allegretto Wave Eye-Q successfully addresses some serious downsides and complications of other refractive lasers. This is accomplished through precise eye alignment for accurate centration, and high-speed, automated eye tracking to compensate for the pupil shift due to the eye’s saccadic (normal tiny) movements. A decentered treatment can result in halos, increased glare, double vision and reduced visual acuity. Safety and precision in alignment are imperative for accurate results in all cases but especially in complex cases involving corneal astigmatism.

At Gotham Lasik Vision we only want the best for our patients and that is why we offer custom refractive surgery using the Allegretto Wave Eye-Q!

ARMD is a disease which affects the back of the eye, the retina, and in particular, the central part of the retina. This affects the central vision; think about a picture with a blurry spot in the center with the surrounding area in focus. This loss of central vision effects reading especially and loss of recognition
of a person’s face when looking at someone. As Dame Judi Dench states : “I can’t read scripts anymore because of the trouble with my eyes. And so somebody comes in and reads them to me, like telling me a story.” And “The most distressing thing is in a restaurant in the evening I can’t see the person I’m having dinner with,” – though the outline of the person is clear, the face is a mystery.

As she remarked, her mother had this condition before her – the incidence is greater if a blood relative is affected. Macular degeneration is handled in a variety of ways. Special lenses and glasses can help, along with video tools to aid in reading. We’ve discussed nutritional benefits to slow down the progress of the disease and new therapies involving drugs and lasers can help dramatically in the ‘wet’ form of the disease. New modalities, including surgery are being examined.

A brief recap of the nutritional benefits of certain vitamins and compounds. There may be a reduction in the risk of ARMD with consumption of foods high in lutein and zeaxanthin. Additionally omega-3 fatty acids may reduce the progression of ARMD in its early phases (along with low glycaemic index foods). The over the counter supplements sold for eye health may slow ARMD but have not been shown to be of benefit in the general population that doesn’t already have ARMD. And care should be exercised with these because components of these supplements may do harm – beta carotene in smokers increases the risk of lung cancer and vitamin E may increase heart failure in at-risk populations.

Glaucoma, on the other hand, generally affects one’s peripheral or side vision. It is a slow but progressive disease, usually not noticed until very advanced, when it can encroach on a person’s central vision and then lead to complete blindness. Since symptoms only occur in the late stages, it is advised that everyone have regular eye exams with a check of the eye pressure and a look at the optic nerve at the back of the eye. Glaucoma can be treated with eyedrops, laser and/or surgery but is best if caught early when the progression can be halted.

By Carrie Rossenfeld

While hard surfaces can look modern and edgy (and are often easier to keep clean), they’re not always welcome in the medical office setting. Stone, tile and hardwood floors, along with metalframe chairs and glass tables certainly look nice, but they have definite drawbacks for practices, including a lack of comfort and privacy, risk of injury, increased noise and an overall “cold” feeling.

The current trend in medical office design is to make these spaces feel more residential and less clinical, which calls for a softer touch. “This connects the human experiences of sight, sound, texture and movement with furniture and furnishings that feel more hospitable,” says Ashley Ginn, design manager for Shaw Contract Group’s healthcare and education studio in Cartersville, Ga.

“Creating softer surfaces in waiting/exam rooms can help make these spaces more approachable for patients, and can help lower acoustical noise, which has an added benefit of increasing patient acoustical privacy,” says Neil Chambers, CEO and founder of Chambers Design, Inc. in New York City. Decreased environmental noise is also linked to better healing, according to The Center for Health Design.

In addition, slipping and falling is more common on hard, slick surfaces, adds Barry Dubrow, president of Dubrow’s Discount Office Furniture in Cherry Hill, N.J.

Hard surfaces on vertical and horizontal planes also produce a glare and reflective issue, which can be both uncomfortable and anxiety-provoking, says Dan Lee, CEO and president of Lee Design Group PLLC in Dallas. In fact, all of the negative effects of hard surfaces can increase anxiety, fear and alarm in patients.

“Creating a warm and comfortable, ‘soft’ atmosphere to the waiting area is a step in subverting these fears and anxiety,” says Brian A. Bonanni, M.D., medical director for Gotham LASIK & Skincare in New York City. “It lends [itself] to a more relaxed and intimate relationship with the doctor and staff, leading to a better experience and better healthcare.”

How can you soften up your surfaces?
There are many options for minimizing unwanted hard surfaces in your office. Here, MOT shares some tips from design experts and knowledgeable medical practitioners alike.

Flooring
Select low-profile (not shag) carpeting to help prevent slips and falls, says Jeanmarie Zimmerman, associate and design director of Puchlik Design Associates, Inc. in Pasadena, Calif. Also choose durable and solution-dyed carpet that can handle the long-term strain of frequent cleanings as well as wear and tear from walkers, wheelchairs and medical equipment.

Dubrow cautions practices to make sure that sure carpeting is installed properly, without any exposed tacks or bubbling, to prevent trips and injury.

Try carpet tiles instead of traditional broadloom carpeting. “If a section of carpet gets damaged or stained, it can easily be removed and a new piece installed,” suggests Michael V. Swain of Wood Burghard Swain Architects in Irvine, Calif. Even better, carpet tiles are consider “green” or sustainable because they can be replaced in smaller pieces without the waste of replacing all the carpet.

For exam rooms, sheet vinyl, VCT (vinyl composite tiles) and rubber plank/tile flooring are great options that are easy to clean and yet comfortable for standing and walking. Some specialty resilient floorings, such as vinyl, can include a backer mat to assist in cushioning and support, eliminating the need for ongoing wax maintenance while securing the desired level of friction and providing better patient comfort and safety while walking, Zimmerman adds. You can soften the floor visually by using vinyl floor tiles that resemble wood, while welded-seam sheet vinyl with integral cove base is the most robust option, says Swain.

The judicious use of area rugs can soften a space, says Bonanni. Make sure they have a non-slip backing and are cleaned often.

Furniture
Fabric-upholstered furniture rather than harder upholstery vinyl improves privacy and comfort, Lee contends. Today, there are a number of fabrics that resist bacteria and staining, which is one of the main reasons why medical practices have shied away from upholstery.

Minimize or eliminate glass-top tables in waiting areas, suggests Maureen Carley-Vallejo Iida, a senior designer in the healthcare group at Perkins Eastman, a firm in Washington, D.C., that specializes in healthcare design. Also, look for soft or eased edges on chair arms, tables and other surfaces.

“Couches are so much more comfortable than a straight-backed chair,” says Sandra Lee Hartsell, an LPN in Thomasville, N.C. Consider upholstered couches or loveseats in your waiting room to replace some individual chairs and to help create a homier atmosphere, suggests Bonanni.

If appropriate for your practice, look into specialized bariatric and hip-injury chairs for waiting areas, says Zimmerman. These are often available from designated healthcare lines that are engineered for patient safety and include rubber cushions on arm rests to assist elderly or injured patients in the process of sitting and standing, and they are usually suitably weighted at the base to prevent instability or tipping. Also consider cushioned benches next to the reception desk so that patients don’t need to stand when talking with a nurse.

http://www.medicalofficetoday.com/content.asp?article=5285

ROP is thought to be caused by irregular growth of the blood vessels in the back of the eye (the retina). This can lead to scarring and retinal detachment leading to blindness. ROP is linked to prematurity (born before 30-32 weeks gestation) and the risk increases with very low birth weight(1500 grams or less), and both oxygen toxicity and hypoxia are contributing factors. Children with ROP are at greater risk of glaucoma, ‘eye turn’ (strabismus), cataracts, and myopia(nearsightedness). Diagnosis is done by eye exams performed on premature babies at regular intervals.

Avastin is a cancer drug originally approved to treat breast cancer but is being used for retinal eye diseases such as age-related macular degeneration. [The FDA may rescind its conditional approval for the treatment of breast cancer due to sine possible side effects. The dose used for retinal diseases is much lower and no side effects similar to those found in breast cancer treatment have been observed.]

The standard treatment today is Laser ablation of the peripheral retina which can stop the progress toward blindness, but it also may cause infants to lose peripheral vision and suffer from poor overall vision.

Only 4 percent of babies treated with Avastin suffered a recurrence of ROP compared to 22 percent in the laser ablation group. Treatment with Avastin cost about $40 for both eyes. Further research needs to be done to determine the best timing of the Avastin injections and to determine the best appropriate dose for the different forms of ROP.

Previous studies like the AREDS found that omega-3 intake might protect against advanced AMD. Macular Degeneration is a disease of the retina (the back of the eye) which has high concentrations of omega-3’s. The first study involved seniors aged 65 to 84 who were evaluated for AMD and graded as to extent, from none to advanced. Interestingly, all groups consumed fish, but those in the advanced AMD group were significantly less likely to consume high omega-3 fish.

In the second study, which involved following more than 38,000 women with no AMD over a span of 10 years, information on the intake of the omega-3 fatty acids found in fish, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), along with arachidonic and linoleic acids (omega-6 fatty acids) was garnered. Women who consumed the most DHA compared with women who consumed the lowest amount had a 38 percent lower risk of developing AMD. Similar results were observed with higher intake of EPA and both types together. Consumption of one or more servings per week had similar reductions in AMD when compared with consumption of less than one per month. Consumption of the omega-6’s had no significant association with AMD.

Good sources of omega-3’s are cold water oily fish such as sardines, anchovies, mackerel, herring and salmon, tuna as well as several types of shellfish. In addition to the health benefits regarding AMD, the omega-3’s also play a role in treating Dry Eye Disease. All very good reasons to consume heart healthy fish.

Now however, there may be hope for some of these bad cases. Researchers in Ottawa and Sweden have developed a new bioartificial cornea – a way to regenerate the cornea from within. With about 42,000 corneal transplants in the U.S. yearly and an estimated 10 million people worldwide with corneal blindness the need for donor corneas is high and the supply inadequate. Even with donor corneas, rejection is always a risk.

The researchers took human collagen and molded it into a contact lens-like shape providing a scaffold for a cornea. After damaged tissue was removed in 10 patients with severe vision loss, this corneal lens-film was implanted. Not only did it act as a replacement for the damaged corneal tissue but, what was truly amazing, was that healthy corneal cells started growing in the collagen forming a normal structure. Tear production normalized and even corneal nerves re-grew – a significant requirement for normal function. Though this was performed in patients with more superficial layer corneal diseases, the ultimate goal is to utilize this advance to treat patients with deeper corneal layer disease, obviating the need for full-thickness corneal transplants and potentially making the supply of artificial corneas widespread and capable of worldwide distribution.

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