DR. JOSEPH DELLO RUSSO

As reported at the ACVO annual meeting in Waikoloa, Hawaii, there has been an alarming rise in fungal infections among lens wearers. Causes may be related in part to lens solutions as well as poor hygienic care by patients. There is a large percentage of patients who suffer some loss of vision, nearly one third requiring a corneal replacement to restore sight.
 
The rise in fungus infections was noted first in 2005 by the CDC, and it is often associated with loss of sight.

 
Editor’s note: this report is consistent with a report issued by Dr Dello Russo in 2007.  

At a recent meeting of the Council on Refractive Technology, Dr. Michael Twa discussed the most significant risk of Lasik, kerectasia.

Kerectasia was a little-known corneal disease, most often an inherited tendency which as one ages into their twenties and thirties leads to poor vision by a progressive worsening of the shape of the cornea, becoming thinner and malformed. It was a disease only rarely seen by cornea specialists.

We now know that with the blossoming of lasik some of these genetically predisposed patients can be made worse if they undergo Lasik. Lasik became very popular from about 1997-2004 with significant kerectasia patients made worse, speeding up the natural worsening that would normally only occur with age.

Since the average Lasik surgeon never saw kerectasia before, they were not aware that Lasik could speed up the genetic process, therefore a surprising number of Lasik people developed kerectasia, not right away but within 24 months.

The Lasik community did not become aware of this effect until about 2003. This has lead many surgeons to abandon Lasik and select PRK for patients.

The most important way of preventing Lasik patients from developing kerectasia is to identify those with a genetic tendency for kerectasia. Instruments in the 1990′s and early 2000′s simply were not sophisticated enough to identify all potential cases before surgery.
 
Editor’s note: Current instruments are able to identify abnormal corneas most of the time, but the surgeon must use his/her experience and judgment to interpret these tests.

As reported in the January journal of Ophthalmology Times by Dr. Talamo, a noted Boston Lasik surgeon, the no-blade or Intralase method of creating the flap in the first step of the lasik procedure is now becoming the standard of care in the industry.

Editor’s note: Dr. Dello Russo was the first Lasik surgeon to introduce the Intralase laser to the nation and beyond in February of 2002. It has been his “standard of care”.

As reported in the December edition of Ophthalmology Times and by Dr. Talamo of Boston, patients now have choices in the type of lens implant that they can choose to replace their clowded lens (cataract).

They used to have no choice. Surgeons had only a choice between brand names, not types of implants. Over the past few years there is a whole stream of implants that have emerged on the market, designed to not only give good distance vision but some near vision ability as well. Every lens supplier has its own patented “multifocal” implant. Now the doctor can adjust the choice according to a person’s individual needs.

Editor’s note: expect new varieties to not only address far and near vision, but also astigmatism.

As reported in the December edition of Ophthalmology Times, there is a general consensus that the incidence of dry eye following Lasik is decreasing, according to Dr. Maldonado, since surgeons are eliminating candidates who demonstrate some degree of dryness during Lasik evaluation.

Editor’s note: it is necessary to treat any dryness that a potential Lasik patient may have before Lasik. Many techniques exist, such as lacrymal plugs, drops (both lubricating and curative), ointments, etc…

As reported in the December edition of Ophthalmology Times, refractive companies are merging and/or being engulfed by giant companies, as for example Bausch and Loumb, Advanced Medical Optics, Wavelight, Alcon, and Allergan.

Editor’s note: We may be headed for a total of only three major companies in the refractive (Lasik) industry. Some feel that this will discourage the small start-ups that often introduce new technology. I personally do not agree. The ability of a start-up to eventually be bought up is encouraging to the small company, often strapped for cash to push a new technology all the way through R&D.

EyeWorld Week February 27, 2008

A study reported on the online web site of Eyeworld Educational Symposium, preschoolers with poorer unaided vision perform lower on developmental tests.

According to the study performed at Shiley Eye Center these same poorer-scoring children experienced an improvement when retested six weeks after being prescribed glasses.

These developmental tests are thought to be indicative of success in school.