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. 

From a study that appeared in the Review of Optometry, February 15th, 2008.

Wine helps prevent cataracts? That is what a study by Dr.Paul Kopecki concluded after a five year study at Rekjavk Eye Center.
 
Researchers believe that regular consumption of red wine in moderation allows the French to counter-balance their fatty diets and live healthier lives, possibly living as much as ten years longer than others. The Rekjavk Study also indicated that moderate drinkers of red wine seem to be less prone to developing cataracts as well as retinal degeneration, which are both aging problems. Researchers believe that red wine contain antioxidents that are beneficial to a healthy diet.

One of the most discussed topics at the Eyeworld meeting in Mexico (February 2008) was presented by Drs. D. Koch, H. Wu, T. O’Brien and Robert Osher who explained that cataract surgeons now have greater choices when performing a cataract surgery. They can often customize lenses for the needs of the individual patient.

Not long ago the cataract (cloudy normal lens of the eye) was removed and replaced with a lens or an implant powered to focus for distance alone. Reading glasses were required for nearsightedness. New implants are now available, providing not only give distance vision but also some degree of reading ability. Also available are implants corrected for astigmatism, that would be left after conventional cataract surgery.

Editor’s note: as exciting as these new implants are, recently developed lenses have been used on people without cataracts but who have a prescription that is beyond the treatment range of Lasik. These “phakic” lenses are implanted in front of the normal lens. People who have had this lens implanted have been exceedingly happy within our practice, but this technology is still young.

As appeared in the Ocular Surgery News of Jan. 25, 2008

Dr. Marcelo Netto discussed some of the uncertainties that he observed about preventing Kerectasia. He noted that he was often surprised that some patients with multiple risk factors for ectasia had uneventful Lasik surgery, which is something that is genetically known.

He went on to discuss some risk factors most often picked up at a good screening before Lasik which are generally well known nowadays.

He did note that the disease probably starts on its own in the early twenties and that patients often have a family history of the disease. He noted that kerectasia is most likely to occur in patients with some signs of the disease and are to be screened out.

Where this editor disagrees with Dr. Netto is that PRK can lead to ectasia. Performing PRK from 1990 on I have never run into ectasia after PRK.

He did note also what we all know as true that ectasia also occurs in patients without any known or diagnosable kerectasia risk factors.

He went on to describe some of the tools that are currently available for us to screen out potential or early ectasia, which we did not have in the 1990′s or early 2000′s, even until a couple of years ago.

From a study appearing in Eye Net , a Journal of the AAO, February 2008.

Many people who spend much time on computers especially daily at work may often experience eyestrain. The main cause of the discomfort is that the tear film of their eyes may not be healthy due to several reasons.

One cause is that some people do not blink enough to freshen and the tear distribution on the surface of their eyes. In essence, they tend to stare at the computer, blinking less than the average of twenty times per minute. A second reason for the poor tears is that many people simply develop a very mild but persistent inflammation of the lid tear glands which allows for less than normal tear production. Drying of the cornea is also worsened in some people who wear contact lenses, which tend to absorb some of the normal tears produced.

Editors note: If you suffer from computer eyestrain, try to make yourself conscious of blinking more often than you presently do and keep a bottle of wetting drops within reach of the monitor.

The Bausch and Lomb “Run For Vision”, held during the American Academy of Ophthalmology meeting, attracted 253 participants and raised a sum of $12,000 for the needy New Orleans Eye Bank.

Editor’s note: long distance running is quite popular among ophthalmologists (no longer for this editor)…

As recently reported in the journal of Ophthalmology Management, a recent study conducted by The Contact Lens Council indicated that 11 million of the 35 million contact wearers do not take proper care of their contact lenses.
 
Recent alerts by the FDA warning of loss of sight by one of 2000 lens wearers seem to substantiate the results of the CLC study. Additional council results may be found at www.mycontactlens.org
 
Editors’s note: It has been known that some percentage of people abuse the use of contacts, feeling there is no danger at all: “I’ve been sleeping with my contacts for years and never had a problem”. This quote is familiar to all eye doctors when caring for a patient who has finally developed a severe infection from using contact lenses incorrectly.

A new article in Primary Care Optometry News suggests that people with certain health conditions, such as Rheumatoid arthritis, Lupus, Spondylitis, Chron’s disease, Diabetes, and even pregnancy and breast feeding, may be good candidates for Lasik.

Dr. Dello Russo explains: “the systemic or general body diseases noted in this review are not approved by the FDA for lasik, not because they have been proven to be harmful. On the contrary – the laser manufacturers simply have not performed studies with their lasers on people with these general diseases, so the FDA does not know what would be the results of performing Lasik in patients with these groups of diseases. Therefore people who suffer from these maladies are not “approved” since they were never tested by the laser companies.”

At a media event held today at the Dello Russo Laser Vision Center in Manhattan, New York, prominent lasik surgeons Drs. Joseph and Jeffrey Dello Russo introduced the most advanced eye laser by Swiss laser maker Alcon, which goes “beyond Custom-cornea”.

Since Dr. Joseph Dello Russo introduced laser eye surgery to the nation in 1990, he has long been associated with the “firsts” in lasik evolution, leading the implementation of procedures such as Down-Up, Flying-Spot, Tracking, and in recent years the No-blade lasik (2002), as well as Custom-Cornea by Alcon (2003).

Alcon, Inc. has now chosen Drs. Dello Russo to introduce their newest laser: the Eye-Q, the thinking man’s laser. Alcon believes that it is currently the most advanced laser in the market. Although lasik is considered quite safe nowadays, the EYE-Q is more precise than other lasers since it only performs “customized” lasik on patients, reducing and even improving some side effects.

Each patient receives a treatment unique to his eye structure so that each person reaches his maximum vision potential. No two treatments will likely be the same. “Along with the greater precision is less need for enhancements”, explains Dr. Dello Russo.

Patient comfort has been enhanced by the speed of this new tracking flying-spot laser. The average treatment takes about 10 seconds, allowing a more comfortable laser experience. Dr. Dello Russo reminds us that the no-blade laser takes merely 20 seconds to make a flap. Coupled with the speed of action of each of the two lasers is the lack of need for drops which makes the overall lasik procedure last only a few minutes for each eye.

Drs. Dello Russo stated that “just when you think lasik can’t get any better, Alcon offers an improved laser technology that takes us even beyond Custom-cornea. The Alcon EYE-Q, THE THINKING PERSON’S LASER.”

Dr. Joseph Dello Russo has announced in an interview that for the first time NASA has approved the advanced “all-laser” Lasik to improve the vision of its astronaut candidates, many of whom fail because of vision requirements that are not met.

Dr. Dello Russo introduced the all-laser Lasik in his New York City office in February 2002 as a safer and the more precise lasik. The National Aeronautics and Space Agency (NASA) will now accept candidates that failed the vision requirement if they undergone a Lasik procedure. However, the procedure must be performed without the use of a blade, which is known as Intralase Lasik or all-laser Lasik.

NASA is following the lead by other branches of the US military which after an extensive study determined last November that all-laser lasik is safe for the military, especially for soldiers in combat.

The extreme zero-gravity conditions of NASA pilots, mission specialists, and payload specialists make even simple contact lenses intolerable. More astronaut candidates with vision problems will now qualify.

“The decision by the military and NASA reflect how safe this type of lasik is now considered”. Several months ago Dr. Dello Russo reported that “Lasik surpasses in safety even the wearing of contact lenses.”

Lasik is the most popular self-improvement procedure in the US with over 11 million procedures performed since 1996. Until introduced by Dr. Dello Russo in 2002, the procedure was performed with the use of a blade, which was unfortunately associated with some complications.

“The intralase all-laser lasik is now the standard of care”, says Dr. Dello Russo. “Our office has been proud in being the first in recognizing its safety and precision and pioneering its use over the past five and a half years.”

The following is a summary of a recent Aug. 31, 2007 NY Times article with Dr Dello Russo which discussed Lasik financing, as well as an evening news MSNBC article from Sept. 2, 2007.

Much has been written lately about the credit market but one area of credit is just beginning to prosper: financing medical as well as cosmetic surgery!

Cosmetic surgery like LASIK, which is used to get rid of glasses at about a rate of 1.5 million a year is increasingly being financed, sometimes at no interest penalty at all. Lasik is not covered by medical insurance so it demands a certain amount of discretionary income. Depending on a person’s credit rating, one may have lasik with Dr. Dello Russo of New York and New Jersey and not pay a penny for 12 months at which time the loan comes due and may to be paid without any interest at all. 

DR Dello Russo says that the patient arranges with the credit company to pay him and will then repay the lender according to their agreement either with no interest or heavy interest. The doctor himself plays no part in this arrangement, except to make the introduction of the patient to the lender and then allow them to work out their own particular agreement if any. 

Dr. Dello Russo says that  financing has allowed those who cannot pay in full at the time of surgery an opportunity to pay over a period of time. It has encouraged patients to undergo LASIK and all seem to benefit. Dello Russo says that it took him a while to get used to accepting independent financing in his office, but then again it took him longer to adapt to accepting checks and later longer yet to accept credit cards way back when.

Six years ago, Dr. Joseph Dello Russo founded online Lasik FAQs (Frequently Asked Questions) web site in order to provide answers to the most common questions that trouble Lasik patients and surgery candidates. It has since become one of the most popular Lasik information websites, currently serving 50,000 visitors each month — traffic has tripled since January 2007.

Dr. Dello Russo is one of the nation’s most well-known Lasik surgeons, one of the few who worked with FDA to approve the first Excimer Lasik technology. Following the Lasik approval in 1998, he noticed people’s confusion and received many phone calls and emails with questions from the public who was becoming aware of Lasik but knew little about the new surgery. “Patients complained that they could not find any reliable source online which can provide them with relevant, fresh information on Lasik-related issues,” he explains the reason he opened www.LasikFAQ.com in 2001. “I went online and found that there were no significant laser vision correction Q&A websites. Most Lasik message boards or chats were not managed by eye doctors. Someone had to take the initiative to educate the public.”

Dello Russo sought to provide a totally objective informational Lasik site, the content of which would reflect what questions were on the minds of the public who were considering Lasik: “I decided to choose a question and answer format, so people can browse through past questions and find information quickly.” The website is ad-free, hosted by Dello Russo Laser Vision centers. Dr. Dello Russo answers most of the questions himself: “sometimes it resembles a chat room when I have enough free time for act with questioners. I focus on a common problems and new developments”. On LasikFAQ.com, Dr. Dello Russo writes as an educated but independent advisor who answers questions from around the world. He normally avoids mentioning brand name products, if possible.

Traffic to LasikFAQ.com keeps surging, especially in the last few months, following an online campaign. Both Google and Yahoo link to the site’s answers for popular questions such as “how long does Lasik last?” and “how old do you have to be for a laser eye surgery?”. Dello Russo says that others choose to ask personal questions with a lot of detailed information, which has sometimes prefers to answer privately.

This is not the only online public service Dr. Joseph Dello Russo has developed. In October 2006, he opened a personal blog (www.drdellorusso.com) in which he refers to new laser eye surgery technologies, marketing practices and even recollections of the development of Lasik. Dello Russo recognized the opportunities in going online early on, and set up two practice sites back in the early internet days. Dr. Dello Russo reports that overall traffic to all of his websites has reached more than 100,000 visitors last month.

Dr. Dello Russo wished to emphasize that the information on LasikFAQ.com is delivered without any form of warranty expressed or implied, represents the opinions of Dello Russo Laser Vision and is not to be considered medical advice of any kind nor a substitute for a consultation with a medical doctor or health care professional. Dello Russo Laser Vision assumes no liability or responsibility for any claims, actions or damages resulting from information contained on www.lasikfaq.com.

NEW YORK, May 29 /PRNewswire/ — Some say that there are only two certainties in life: “death and taxes.” Joseph Dello Russo, M.D., a prominent LASIK surgeon would suggest another: the need for wearing reading glasses after forty, a condition doctors call Presbyopia. .

Dr. Dello Russo has aligned himself with a team of researches who in the past have developed some of the most important advances in LASIK. They are now hard at work with what may be a most promising treatment for Presbyopia using a simple LASIK-like procedure to restore reading ability, known as accommodation.

“Restoring reading after the age of forty is the last frontier in laser surgeons’ quest to rid people of eyeglasses,” says Herman Sloane, M.D., a successful LASIK surgeon in Chicago. “I believe the potential is huge, since there are at least 100 million Americans wearing reading glasses who may be willing to have the procedure as long as it is both safe and effective. This could be an even larger market than LASIK encompassing the baby boomers who potentially have more disposable income.”

Dello Russo, who played a prominent role in the clinical trials as a former FDA researcher by helping to develop and improve the laser surgery procedure now known as LASIK, explains that the new approach for treating Presbyopia will be designed to restore the eye’s focusing ability, utilizing a unique laser technology.

Many of the same scientists and ophthalmologists who played significant roles in developing LASIK are again involved in this new research. Dello Russo feels that this experienced team of scientists may have the best opportunity of conquering the “last frontier in ridding people of glasses.”

According to recent statistics presented by Shariff Mondavi, an industry analyst writing in this month’s Review of Ophthalmology, LASIK is the most popular elective surgical procedure in the U.S. LASIK treats nearsightedness, farsightedness and astigmatism, conditions which interfere with distance vision and which unlike Presbyopia, do not occur in all of the population. Of those who could benefit from the LASIK procedure, approximately 5% have chosen to undergo this procedure in the decade since LASIK was introduced. Presbyopia occurs in everyone, so eventually, any person can be a potential customer.

Financial analyst, Gary Hager of Manalopin, New Jersey and Palm Beach, Florida, states, “Wall Street would love to embrace a technology that could create an entirely new industry.” However this will not come cheaply. He believes that as much as $75 million will be needed to bring this technology to market. This type of company (LenSar) with its potential for high growth and huge earnings makes it very attractive. The Street knows that it’s less expensive in the long run to finance a new company with great potential in its early developmental stages than for major industry players to buy in at the top after it is a success.

Advanced Medical Optics recently purchased VISX, Inc. for $1.2 billion, and more recently Intralase for $808 million. “A cure for Presbyopia could be a billion dollar industry and the growth potential is enormous, if successful,” says Hager.

Dr. Dello Russo says, “There are no guarantees that this laser technology will work. It will take at least five years to bring this through the FDA approval process. However in 1990, we had no guarantees that laser vision correction (LASIK) would succeed. Now it is a multi-billion dollar industry. We are encouraged so far with the results of the animal studies as we move on to the human trials, we think that this team of smart and experienced scientists has the best chance of succeeding,” says Dr Dello Russo.

The following reprint relates to an advertising offer often made by discount lasik centers (read more here).

Discount franchise centers have a poor financial history since they frequently go out of business by charging low prices for Lasik. So when you hear of a “lifetime guarantee”, I often wonder “whose life?” The doctor’s? The center’s? The patient’s? How good is an offer from a type of centers which historically go out of business quite frequently?

Also, why would a person need a lifetime guarantee? when Lasik is well done by a good surgeon on a good Lasik candidate, it is permanent. So, what is being guaranteed? Nothing is being offered.