alue
s

Patient EC is a 53 year old white male who presented with poor distance in his right eye 3 years after undergoing an INTACS procedure. Distance visual problems included severe ghosting and distortion of images, especially in the right eye and worse in dim illumination. His preoperative prescription was -1.75 in both eyes. His medical and family histories were unremarkable. He was not taking any medications. He did not exhibit any clinical signs of dry eye and showed no ocular signs of GPC or other eyelid anomalies.

Uncorrected visual acuity is 20 / 30 and 20 / 20 right and left eye respectively. With a glasses correction of +0.50 -2.25 x 110 and -0.25 -0.50 X 110, the patient could see 20 / 25- and 20 / 20. Ghosting was greatly reduced, but a trial fit of the glasses prescription made the patient feel very disoriented and dizzy. Topography of the right eye follows. Corneal Topography before (left picture) and after (right picture) insertion of Focus Night and Day contact lens.

Diagnosis: Irregular Astigmatism of Unknown Origin

An attempt was made to fit the patient in 8.4 base curve, +0.50 Focus Night and Day contact lens in the right eye. Acuity improved to 20 / 20- with the contact lens on after 30 minutes. The patient did, however, notice an immediate improvement in visual sharpness even though acuity improved less than 1 line of letters. Topography over the top of the contact lens shows reduction in the irregular astigmatism. The patient was able to tolerate the lens extremely well and wound up wearing the lens continuously for 3 weeks time. Topography measures were repeated weekly to insure progress. After 3 weeks of wear, the double vision had been eliminated and visual acuity had returned to a sharp 20 / 20.

Observations: This is a classic example of how some problems can be "fixed" with simple and straight forward solutions. While this patient improved visual acuity only slightly, his higher order aberrations were decreased more than 50% by simply wearing the soft contact lens. The "stiffer" material used in the Focus Night and Day does a good job in optically "smoothing" the outer surface of the cornea and can be credited with improving the patient's vision. Caution should be exercised when attempting such a fit to make sure that the patient is able to comfortably wear the lens. Topography over the top of the contact lens will often show a reduction in the amount of corneal astigmatism. Care must also be given to fit a material that is more likely to maintain sufficient lens hydration to avoid concurrent visual blur due to disrupted lens optics.

To submit an article, contact lens or surgical case case report, please email
Co-MedicalDirector@surgicaleyes.org.

s
If you have postrefractive patients with long-standing complications, what is the complaint you hear most often?

1) Dry Eye
2) Quality of Night Vision
3) Quality of Day and Night Vision
4) None of Above
5) All of the Above

Please click here to answer the above poll. s

Last months poll results:

How do you diagnose dry eye in postrefractive patients?

1) Clinical signs, including shallow tear lake and punctate staining - 17%
2) Clinical tests, including Shirmers - 0%
3) Combination of all - 66%
4) Other - 17%
5) None of the above

s
Mismatch between the flap and stromal areas after laser in situ keratomileusis as source of flap striae. William N. Charman, DSc. Journal of Cataract and Refractive Surgery: Volume 28 Number 12 (December 2002) Pages 2146–2152.

Researcher theoretically calculated the magnitude of the excess area between the lower surface of a LASIK flap and the underlying ablated stroma. Noted was the effect of the geometric mismatch that could have clinical consequences. More

Fenestrations Enhance Tear Mixing under Silicone-Hydrogel Contact Lenses. Naoko Asano-Kato aAIkuko Toda, et. al. American Journal of Ophthalmology; Volume 134 Issue 6 (December 2002) Pages 801-807. Twenty subjects were fitted with two pairs of silocone hydrogel, one pair with fenestration to investigate the effects of fenestrations on tear exchange under an SCL. Tear-mixing efficiency was improved and tear-film thickness needs to be quantitatively measured to accurately predict the effects of lens parameters on tear mixing. More

Reading the waves: Recognize common problem patterns Marguerite B. McDonald, MD. Eyeworld; Volume 8 No 1 (January 3, 2003) Page 36. More
Research Editor Note: This article is interesting, not because of the hype of fixing the vision quality problems caused by refractive surgery, but because wavefront measurements are now providing objective evidence that a sizeable number of people really do not see very well after refractive surgery. In the past few months there has been a slow shift in the RS industry journals away from the hype of correcting everyone to 20/15 and 20/10 to a recognized need to be able to correct people to a good quality 20/20.
s

s
Dr. Grant Mason

B.Sc.Optom. Melbourne University, 1984; M.Optom. University of New South Wales, 1996; Fellow, Australian College of Behavioural Optometry; Fellow, College of Optometrists in Visual Development; Level 2 Sports Vision Accreditation, Sports Vision Australia.

Member, Optometrists Association Children's Vision Taskforce, 2002
Member, Optometrists Association Public Awareness Committee, 2000-
Head Examiner, Sports Vision Australia. 1997-
Senior Optometrist, Sydney Olympic Games, 2000
Senior Optometrist, Special Olympics, 2002

Family - married, two sons, one daughter, two dogs and a tank full of fish.

Hobbies - Finding time to fit hobbies in, Science fiction novels, Star Trek videos (TNG still rules), Red Wine, driving with my car roof down.

Optometry is a profession that provides both an intellectual challenge and spiritual satisfaction. I find it rewarding to help others and derive great satisfaction from seeing patients progress in life with my assistance.

s

Future Profiles to follow from Top Doctor Posters on our Bulletin Board:

W Trattler MD, Gregg Russell OD, Ken Minarik OD, Frank Holly PhD, Ophthinfo MD, James Salz MD, Clint Hoxie OD, Tracy Lynn Swarz, OD, Donald F. Ezekiel OD, Steven Lee OD, Sam Omar MD, Alejandro Tirado OD, Demetrian Dornic MD, Ricardo Trigo MD, Arthur Epstein OD, Chris Marmo OD, Hollis Stavn OD, Eirit Yonatan OD, Paul Klein OD, Robert Bard OD, Neal A. Sher MD, Dan Reinstein MD, Jim Dillard OD, Gregg Feinerman MD, Steven Shum OD, Richard Bursua OD, Jason Jedlicka OD, Mark Ventocilla OD, Barrie Soloway MD, Carlton Chan OD, Jack Miller OD, Brian Boxer Wachler MD, Ken Maller OD, Joe B. Goldberg OD, Bruce Butts OD, Kraig Abe OD, Paul Blaze OD, Frank Goes MD, Bill Berke OD, David L. Davidson OD, Joe B. Collins OD, James Stevenot OD, Jeffrey Martin OD, Johnathan Christie, OD.
s

Custom Cap Report

How Accurate is LASIK in Correcting -.50?

Pilocarpine Worries - Need Doctor's Opinion

Iatrogenic keratectasia: Current knowledge, current measurements

New eye drop for dry eyes

Does your Anger Increase or Decrease Over Time?

• Live Chat with participating doctor, Ken Minarik, OD at on Sunday, January 12, 2002 from 9 to 11 EST.

• Visit with us at the Contact Lens and Eyecare Symposium Meeting in Orlando, FL from January 22 -26, 2002 in Booth 102. Also at the Symposium - SE participating doctor Frank Holly, PhD will be presenting the The Harold A. Stein, MD, Lectureship on Thursday, January 23rd in room 23-101A Level II.
  
  
• Surgical Eyes Meeting at Cedar Sinai, Los Angeles, CA - Saturday, February 15, 2003. Hosted by SE participating doctor James Salz, MD. Please sign up by February 12.
  
  
• Washington/Oregon Support Group Meeting on Saturday, March 1st, 2003 at Vision NorthWest in Tigard, Oregon, from Noon to 4:00 PM Lunch will be provided from Noon to 1:00 PM with an open meeting from 1:00 to 4:00 PM. John Wilkins, OD will be attending and will answer as many questions as possible. Please contact organizer Brenda Ross for more information!
  
  
• Pictures from our past meetings at Emory - Atlanta, GA and Cohosted by Gelfex - New York, NY in 2002. Some of the presentations made by doctors at both meetings will be available online.
  
  
• Surgical Eyes Meeting at Indiana Eye Care, Greenwood, IN - early March 2003 hosted by Dr. Charles McCormick III.
  
  
• Surgical Eyes Meeting in London, England - early May 2003 hosted by SE participating doctor Dan Reinstein, MD.

s
The Surgical Eyes Web Site received over 14,275,000 hits in 2002 alone. This Newsletter is now featured on the front page of our Web Site and emailed monthly to over 3,280 registered users of the Surgical Eyes Bulletin Board - a technologically sophisticated interactive forum on refractive surgery complications featuring interaction between leading MDs, ODs, PhDs and a caring global network of patient participants.

Place your ad here today!
s

ss
Chief Medical Editor
Gregg Russell, OD

Editor/Art/Production/Circulation
Ron Link
s

s
Research Editors
• Karl Albert
• Mark Bilafore
• Paul Fitzpatrick
• John Vernosky

s
TO SUBMIT AN ARTICLE, CONTACT LENS OR SURGICAL CASE REPORT:

Email Co-MedicalDirector@surgicaleyes.org.

TO SUBMIT NEWS:

E-mail news@surgicaleyes.org or FAX your news to: 813-258-8601.

TO SPONSOR OR PLACE CLASSIFIED ADS:

Surgical Eyes News has over 3,280 subscribers comprised of medical professionals and patients from around the globe.

For information on sponsorships of this e-mail newsletter and classified ads, please email
sponsor-classifieds@surgicaleyes.org.
s