The Customization of Laser Vision Correction

Recent WavePrintÒ  technology has afforded eye surgeons the benefit of customization in laser vision correction procedures.  This is not a new concept to Eric R. Mandel, M.D., founder and medical director of Mandel VisionÒ.  Having researched refractive surgery since the mid 1980’s, he recognized very early in his surgical career the importance of getting to know his patients as individuals.  The difference at Mandel Vision is that Dr. Mandel not only customizes each surgical procedure using the latest WavePrint technology, but he also calls on his years of experience to then personally customize the procedure based on the specific visual needs of each patient.

Surgical Customization

The WavePrint technology in the AMO WaveScan Wavefront System, utilized at Mandel Vision, leads the industry for outstanding wavefront acquisition and diagnostic capabilities.[i]  The WavePrint Map is derived from technology that was first developed to correct distortions of light waves from space.  This technology is now used as a diagnostic and therapeutic tool to enhance our abilities to measure the visual system with an accuracy that was previously unattainable. 

The WaveScan™ captures the unique imperfections of each patient’s eye using all of the available Hartmann-Shack™ data points for more accurate wavefront error reconstruction.[ii]  These data points then create a unique fingerprint of your cornea.  This fingerprint is then programmed into the VISX Star S4Ò Laser for each eye of each patient, individually.  This technology allows Dr. Mandel to correct for visual disturbances, such as spherical aberration, that cannot be corrected with glasses or contact lenses.  This means it may be possible to achieve better vision following laser vision correction than was attainable with glasses or contact lenses before the procedure. 

Individual Customization ~ Dr. Mandel’s Personal Touch

A researcher in refractive surgery since 1984, Dr. Mandel understands the importance of getting to know his patients, including their profession, their hobbies and their passions prior to performing laser vision correction surgery.  Armed with this information, he’s able to customize their laser vision correction procedure.  Although two patients may be the same age and have the same prescription for glasses, they may require different types of laser vision correction treatments. For instance, two 44-year-old patients with similar prescriptions may require completely different approaches to their surgical correction.  A professional golfer, who will begin to lose focus on the logo of the ball which is used for aligning putts, will have different future visual requirements than a commercial pilot who spends the day monitoring multiple computer screens.  Dr. Mandel and our vision correction team take the time to get to know each patient so that we can personalize their projected final outcome.

Here at Mandel Vision, we not only want you to be happy with your visual outcome now, we want you to be happy for life.  

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[i] http://www.amo-inc.com/products/refractive/ilasik/wavescan-wavefront-system.

[ii] Ibid.

Dr. Mandel’s Reading and Computer Tips

Did you know that when you are working on the computer or reading, you blink 60% less than at other times?  This lack of blinking exacerbates dryness, fatigue and discomfort that are often associated with office work. Poor indoor environments, with low amounts of humidity, are another contributing factor.  Think of your eyes as a car’s windshield.  If you have poor windshield wipers, or no windshield wiper fluid, your windshield will be dirty and difficult to see through.  Similarly, you must remember to blink frequently and lubricate your eyes with artificial tear drops, when you are working on the computer or reading, to keep your eyes moist and clear.  This is especially true during the first year after laser vision correction.

Following the simple steps below will make you feel more comfortable so that you can spend more time doing close work without discomfort:

1. For every half hour of reading or computer work, put a drop of artificial tears into your eyes and then close your eyes for 45 to 60 seconds.  (Don’t just look away, but truly close your eyes.)

2. Put a post-it note on your computer, or near your reading material, with the word "BLINK" written on it. This simple reminder to blink really works!

3. Use good lighting for all near vision tasks. An incandescent light, with a rheostat to adjust illumination, is one of the best choices for comfortable reading.

4. Try to get out of the habit of holding reading material too close or moving too close to your computer monitor.  This can strain your eye muscles and cause fatigue.

Happy reading!

How to Choose a LASIK Surgeon

Choosing a surgeon for any procedure can be a daunting task.  This is especially true when choosing a surgeon for laser vision correction, as there are few things more precious than sight.  LASIK is a surgeon dependant procedure.  Akin to a master carpenter with master tools, a highly skilled surgeon and the most advanced technological equipment are required for an optimal result. 

With that in mind, below are some important questions to consider when choosing your laser vision correction surgeon:

Were you told to discontinue the use of your contact lenses prior to your procedure?

Contact lenses, even the soft type, can distort the wavefront reading of your cornea for a week or two after the contact lens is removed.  Because the treatment is so precise and contact lens wear can distort that reading, it’s recommended that patients discontinue their soft contact lenses for 1 to 2 weeks and toric and gas permeable contact lenses for 2 to 3 weeks prior to laser vision correction.  This is to ensure that the most accurate measurements can be obtained.  You want to be certain the measurements are obtained on the natural shape of your cornea and not a cornea molded to the shape of a contact lens.  New wavefront analysis measurements should be taken on the day of your surgery. 

Does the surgeon personally examine you during your evaluation, educate and answer your questions, and personally perform the procedure as well as your post-operative care?

LASIK should be a procedure that is customized to each patient’s individual needs.  To achieve this, a surgeon needs to get to know the patient, their profession, hobbies and the specific goal they would like to accomplish with laser vision correction.  Additionally, there are often adjustments that need to be made with post operative medications to achieve an optimal result, so it’s important that the surgeon follow the patient personally after laser vision correction. 

Is the surgeon using the most advanced pre-screening equipment available?

Pentacam analysis is one of the most sophisticated screening technologies available. It is not necessary to perform on everyone, but a significant number of patients are turned away as less than optimal candidates because of findings that only this machine is able to uncover. 

Is the surgeon using the most advanced technology to perform refractive surgery?

iLASIK is the latest technology and the only advanced all-laser procedure that NASA has approved for use on astronauts.  This technology combines the VISX Wavescan mapping technology with iris registration, the all-laser method of flap creation with the IntraLase Femtosecond (FS) Laser and the CustomVue wavefront guided vision correction procedure with the VISX excimer laser.

 

Did you receive a thorough medical eye examination as a part of the laser vision consultation?

The evaluation process should consist of a comprehensive medical eye examination which includes an extremely precise refraction (measured both before and after dilation), a glaucoma screening, dilation, as well as extensive corneal curvature (topography) and corneal thickness (pachymetry) measurements.  This exam should take a minimum of one hour to complete.

Is the surgeon a corneal specialist?

LASIK is a corneal procedure.  The corneal flaps created in LASIK are thinner than a human hair.  Surgeons who are cornea-fellowship trained are best equipped to perform LASIK, as they are specifically trained in microsurgical techniques of the cornea. 

Is the surgeon Board Certified by the American Board of Ophthalmology (ABO)?

The ABO was the first medical specialty board founded in the U.S. and awards the only medical specialty certificate in ophthalmology recognized by both the American Board of Medical Specialties (ABMS) and the American Medical Association (AMA).[1]  Board certification provides assurance to the public that a physician has successfully completed an evaluation designed to assess the knowledge, experience and skills requisite to the delivery of high standards of patient care in ophthalmology.[2] 

In summary, it’s important to get to know your laser vision correction surgeon prior to undergoing this elective procedure.  In the hands of a skilled corneal specialist, laser vision correction is a safe and very effective procedure. 

About Dr. Mandel:

Dr. Mandel has been a true pioneer in laser vision correction research since 1984.  Dr. Mandel has been board certified by the ABO, in good standing since 1988.  Dr. Mandel is a Harvard trained corneal specialist and is the author of the ophthalmic textbook entitled:  Atlas of Corneal Disease.  Dr. Mandel has performed tens of thousands of refractive surgical procedures.  At Mandel Vision, Dr. Mandel personally examines you before and after your procedure and will patiently answer all of your questions.  Dr. Mandel is also the only exclusive laser vision surgeon in New York named in America’s Top Doctors by Castle Connolly, the most discriminating of the peer surveys, for eleven consecutive years. 

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[1] http://abop.org/board-certification/

[2] Ibid

Flexible Spending Accounts and Laser Vision Correction

If you have a flexible spending account and are considering laser vision correction, now is the time to take advantage of it! 

A flexible spending account (FSA) allows an employee to set aside pre-tax dollars to cover qualified out-of-pocket healthcare expenses.  Qualified expenses include laser vision correction.  These contributions are not subject to payroll taxes, which can result in substantial savings.  Here’s how it works.  Employees are either given an FSA debit card which they can use to pay directly for services using their FSA funds, or they pay out of pocket and then submit a receipt to their employer for reimbursement from their FSA account.

Currently, there is no legal limit to what employees can contribute to their FSA and 78% of large employers set it at $5,000 or higher.[i]  Starting in 2013, when the Affordable Care Act kicks in, the maximum annual FSA contribution for each employee will be capped at $2,500.[ii]  This cap goes into effect based on the calendar year of your particular plan.  Here’s something else to think about:  An earlier version of the Affordable Care Act plan called for eliminating FSA’s altogether, and this could come up again.[iii] 

There is also a deadline for making contributions to an FSA plan.  For most plans that deadline is between October and December for the following calendar year.  This means you would have to contribute in 2012 in order to have access to the funds in 2013. Be sure to ask your plan’s administrator, which would typically be your human resources director, what the deadline is for your particular plan.  Another important aspect of an FSA is the “use-it-or-lose-it” rule.  This means unused money left in the account at the end of the calendar year for the plan is forfeited.  This is especially important for those of you who are considering using flex spending dollars for laser vision correction.  If you deposit money into your FSA account for LASIK or PRK, and are not a suitable candidate, you will either lose that money or be forced to find creative ways to spend it on healthcare.  Therefore, it’s best to have a consultation to determine your candidacy for laser vision correction, or any elective procedure, before making a contribution to your FSA plan. 

The good news is our consultations at Mandel Vision are FREE and extremely informative!  So, you have nothing to lose by scheduling your laser vision correction consultation with Dr. Mandel.  Better yet, you could save yourself a very costly mistake!  Call our office at 212-734-0111 today to schedule your free consultation.  

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[i] http://www.forbes.com/sites/ashleaebeling/2012/06/19/obamacare-calls-flexible-spending-account-use-it-or-lose-it-rule-into-question/

[ii] http://money.msn.com/saving-money-tips/post.aspx?post=2057abe8-8a16-49e3-bb5d-1ddfe62e6705

[iii] http://www.forbes.com/sites/ashleaebeling/2012/06/19/obamacare-calls-flexible-spending-account-use-it-or-lose-it-rule-into-question/

Extreme LASIK:  Taking the Fear Out of Laser Vision Correction

Fear is one of the most common barriers patients face when considering laser vision correction.   Now, thanks to former Navy Captain and ophthalmologist, Steven Schallhorn, MD, patients can feel more secure.  Dr. Schallhorn performed LASIK on military personnel from the Army, Airforce, Marine Corp., and Navy using the same advanced blade-free, Femtosecond and Wavefront guided technology used at Mandel Vision.  In an effort to determine the safety and efficacy of LASIK, he then subjected these patients to some of the most extreme and harsh conditions possible including high altitude, extreme G forces, underwater pressures and blowing sand. 

The results of the clinical trial were crystal clear.  The visual results were excellent and the LASIK flaps were stable, even after being subjected to the most extreme environments. The LASIK flaps even proved to be stable in animal models that were exposed to forces equivalent to those produced during ejection from a plane traveling at 400 knots.[i]  Another concern, particularly for Navy Seals who participate in many night maneuvers, is night vision following LASIK.  Dr. Schallhorn found that night vision actually improved[ii], following LASIK with Femtosecond technology.  This is critical, as many of these maneuvers put these soldiers in life and death situations.  LASIK has enabled soldiers previously ineligible for special forces, due to the need for contact lenses and glasses, the opportunity to realize their full potential in the military.

Additionally, after careful review of Dr. Schallhorn’s data, NASA, which previously banned any laser corrective eye surgery, approved LASIK for its astronauts.[iii]  This decision, made despite the physically demanding, extreme zero-gravity conditions that astronauts endure, was not taken lightly.  Poor vision was the number one factor that previously disqualified many NASA applicants.[iv] LASIK, yet again, has opened the door to allow many more aspiring astronauts the opportunity to realize their dreams of space travel. 

Patients can take comfort in the knowledge that LASIK is deemed safe in even the most extreme environments.  AMO, one of the leading ophthalmic laser companies, says it best:  “Consumers looking for proof that LASIK is safe, effective and advanced enough for them need look no further; LASIK has proven it has ‘The Right Stuff’”.[v]

Click on the links below to view the documentary, produced by Patient Education Concepts, entitled:  LASIK on the Frontlines.

8 minute version:  http://www.youtube.com/watch?v=4q-pbmLr46Q

28 minute version:  http://www.youtube.com/watch?v=awBS2sxNCqU

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[i] Tanzer, David J.Laser Vision Correction in the US Military. Cataract & Refractive Surgery Today. June 2008.

[ii] Ciccone, John. LASIK:  On the Frontlines. ASCRS EyeWorld. February 2012.

[iii] Rundle, Rhonda L. Want to Work in Space? Squinters Can Now Apply.  WSJ, Sept. 21, 2007, Vol. CCI, No. 69.

[iv]Ibid

[v] AMO, Inc., ©2007.  NASA Approves Advanced LASIK for Use on Astronauts  

Mandel Vision® Spring 2012 Health Tips

1. Hooray! Spring is here! Unfortunately, this means the dreaded Spring allergies are here as well. 
With Spring here and all of the beautiful flowers that come with it, comes the promise of the dreaded Spring allergy season. Seasonal allergies are usually due to allergens that bind to mast cells in the eye, which then release histamine. The histamine causes most of the allergy symptoms. Allergic symptoms include itching, redness and tearing. Symptomatic relief can be obtained using antihistamine drops (Naphcon A, non steroidal anti- inflammatory drops (Acular) or steroid drops (Alrex). However, these deal solely with the symptoms, so they only offer temporary relief. To get to the root of the problem, we usually try to prescribe a mast cell stabilizer that prevents histamines from being released. Taken a week or two before the allergy season is in full swing, these drops can really make a difference between a truly annoying allergy season and one that is very tolerable. Combination drops like Patanol, Bepreve, Optivar, Elestat, Alaway or Zaditor all provide protection by acting as both an antihistamine and a mast cell stabilizer, together. Zaditor and Alaway are available over the counter, while the others require a prescription.

2. A Simple Way to Remember to Take Your Medication: 
Remembering to take medication is not always easy, especially if you take more than one medication, and you take them several times a day. A patient shared something with me that can make the whole routine easier and, most importantly, can increase compliance for better results. If you have a smartphone or an iPad, you can download the App: RxMindMe.


3.Why do I need an annual eye exam? 
This is a question I hear almost every day, which is typically followed by: "If I see so well, my eyes must be healthy." Even with excellent vision, you may still have undiagnosed medical issues with your eyes. Many conditions affecting your eyes are painless, and can only be found through a thorough medical eye exam. One example of a painless eye disease is glaucoma, which if untreated can be vision threatening.

Most patients who had a laser vision correction procedure were originally myopic (nearsighted). People who are myopic may have an eye that is anatomically elongated. Unrelated to your previous laser vision correction procedure, eyes that are elongated have a higher chance of retinal problems such as retinal tears, holes and detachments. If you ever experience flashes, floaters or shadows over your vision, go to your ophthalmologist immediately. Even if you do not experience any of these symptoms or they are unchanging, yearly exams may reveal a small retinal tear that could easily be treated, which could prevent the more serious complication of a retinal detachment.

A recent retrospective study confirmed that myopic or previously myopic patients have a higher incidence of open angle glaucoma. This is a painless condition that is easily treated if diagnosed early. Years may pass with undiagnosed glaucoma before a patient notices any visual symptoms. At this point, significant, irreversible damage may have already occurred.

First, don't panic! Most patients do not experience either of these conditions in their lifetimes. However, a simple, comprehensive eye exam is your best insurance against these conditions.

The eyes are really a window into your body. It is the only place where a doctor can actually visualize the tiniest blood vessels in your body, the arterioles and venules. This can reveal the first diagnosis of systemic medical conditions such as diabetes and hypertension.

We hope you found this newsletter informative. Please contact us if you have any questions we can answer for you. You can reach us via email at: drericmandel@mandelvision.com or call us at 212-734-0111. You may also visit our website at:www.mandelvision.com. 

211 East 70th Street • New York, NY 10021 • 212-734-0111 • www.mandelvision.com