What you didn’t know about LASIK surgery:

1. The LASIK procedure takes about ten minutes to complete, though doctors may need a few minutes before surgery to prep patients and a few minutes after to discuss recovery. In fact, a LASIK doctor will only spend about sixty seconds actually excising tissue with the laser.
2. Doctors do not use any needles during laser eye surgery. Many people mistakenly think that laser eye surgeons need to inject anesthesia into the eye or the tissue around the eyes. Instead, doctors simply have patients self-administer anesthetic eye drops a few minutes before the procedure begins.
3. LASIK surgery is not a new procedure. It has actually been around since the 1990’s. However, it has recently taken great steps forward in safety and efficacy. For this reason, an increasing number of people have asked to speak with LASIK doctors.
4. LASIK surgery changes the shape of the patient’s eye. The underlying reason behind the vision problems that laser eye surgery can correct is the shape of the cornea. By altering the cornea’s shape with a few quick bursts from a laser, LASIK doctors can drastically improve vision.
5. In some cases, a patient’s eye will react so well to this procedure that the patient will attain vision that is better than 20/20. This result is most likely when a patient has  laser eye surgery, which incorporates computer guidance into the surgery. According the a clinical study, 70 percent of patients are able to see better than 20/20.
6. LASIK surgery is not restricted to middle-aged patients. Some people worry that they are too old to benefit from this procedure and decide to suffer poor vision indefinitely. This fear is unwarranted: the primary complication with LASIK surgery after a certain age is a patient’s likelihood of getting cataracts in his or her eyes. Cataracts often occurs after 70 years of age, and Omni Eye Specialists specializes in Denver cataract procedures.
7. LASIK most often corrects distance vision. If you undergo this surgery after age 45, you may still need reading glasses even after you experience a full recovery.
8. Patients may be required to stop wearing their contact lenses for several weeks prior to the surgery. This is to help the eye prepare for the procedure.

If you are considering a Denver LASIK procedure, talk to the professionals at Spivack Vision Center®. Here they can educate you about LASIK surgery so that you can go into this procedure with your eyes open.

Cataracts make simple everyday activities that you enjoy such as reading, driving, cooking, sewing and even seeing the faces of friends and family a challenge. Do not be afraid: cataracts–or clouding of the lens–does not happen overnight and is extremely common among individuals of advanced age. However, cataracts can be aggravated if you suffer from diabetes or obesity and can develop faster if you smoke and drink excessively.

It may take years for your immature cataract to mature or become opaque thus hindering your vision completely. However, if you do not treat it in time, it may worsen and reach the hyperactive stage during which the cataract will begin leaking fluid from its stiff exterior casing thus posing the risk of serious eye infection. In order to prevent this, you should opt for a cataract eye surgery performed by an experienced surgeon in Denver, Colorado. The surgical removal of cataracts is a completely safe and most effective way to treat cataract so that you can enjoy the gift of unimpaired vision once again.

About Denver cataract surgery

Phaceomulsification (small incision cataract surgery) is the most commonly performed Colorado cataracts surgery that has helped restore the vision of thousands of patients like you. This outpatient procedure is very safe and involves making a small incision on the side of the cornea to insert a microscopic probe. The probe emits ultrasound waves to soften and break down the cataract clouded lens that is subsequently removed by suction. In the next step, cataracts surgeons replace the natural lens with an artificial lens known as intraocular lens (IOL) that becomes a permanent part of the eye and aids in focusing the light onto the retina for clear vision.

The entire procedure lasts for about 15 minutes and is performed under local anesthesia. Typically, the surgeon will administer anesthetic drops to your eyes a few minutes before the surgery and you will not be required to stay at the facility for more than 2 hours. Since the incision is self-healing, there is no need of sutures. However, it will take up to 3 weeks for you to recover fully from a cataract eye surgery.

After the surgery, follow your surgeon’s advice regarding precautions that should be taken before the surgery. Follow the post-surgery care instructions precisely. These will typically include specific instructions to keep your operated eye clean, taking prescribed anti-inflammation and infection medicines in recommended dosage and avoiding touching your eyes with bare fingers, particularly if they are unclean.

Get your vision–and your life–back

Reclaim the happiness that you felt by participating in simple daily activities such as reading and sewing by getting Denver cataract surgery at Omni Eye Specialists today. Call for more information: (303) 377-2020.

Denver, Colorado is home to avid snow sports lovers of all ages who hit the slopes any chance that they get. If you live for the thrill of jetting down snow-covered slopes while skiing or snowboarding, you are well aware of the importance of getting quality sport equipment and gear.

Get LASIK for better skiing and snowboarding experience!

However, if you wear glasses because of myopia (nearsightedness) or hyperopia (farsightedness), even the best sports gear cannot make your skiing experience as great as it could be: your goggles fit poorly and your glasses fog up. If you face these problems and are looking for a permanent solution for it, you need to learn about Denver LASIK eye surgery.

High-altitude sports lovers who are near-sighted or far-sighted can benefit greatly from LASIK surgery by correcting the vision of the person. LASIK surgery can offer a tremendous boost to his or her performance. Spivack Vision Center® is one of the most trusted Colorado LASIK surgery clinics. The surgeons at Spivack Vision Center® specialize in using the highly advanced excimer lasers that are designed for correcting the widest range of refractive errors through LASIK surgery. Moreover, all the surgeons at this center have more than 30 years of experience in this field and stay abreast with the news of latest technological innovations for vision correction and eye care so that they can offer the best treatment to their patients.

Some things to know about Denver LASIK surgery

Before opting for the LASIK surgery, you should undergo a proper eye exam to ascertain if you are good candidate for this procedure. Ideally, a healthy individual above the age of 18 years who does not suffer from the problem of dry eyes and does not have unusually thin cornea can opt for this procedure. It takes approximately 7-10 minutes to perform LASIK surgery on one eye after it has been numbed with anesthetic drops and the patient can return home soon after the procedure is over.

Once you have laser eye surgery, you need to follow a few post-surgical precautions to ensure a speedy healing process. These include preventing soap water or shampoo from getting into your eyes during bathing, avoiding the use of eye make up for a few weeks and enjoying high altitude and contact sports as a spectator rather than a player until your surgeon gives you the okay.

If your glasses are becoming an impediment to your passion for skiing and snowboarding, get rid of them by opting for Denver LASIK eye surgery at Spivack Vision Center®. Call today: 303-733-2020.

• Omni Eye Specialists
• Spivack Vision Center

We’re looking forward to interacting with our patients in Denver and throughout Colorado on Google+ – please add us to your Circles!

Dr. Spivack rappels down 1600 Glenarm Street in downtown Denver to benefit Cancer League of Colorado

Congratulations to Dr. Lawrence Spivack for his successful rappel off a Denver high rise building.  The event was a fund raiser for the Cancer League of Colorado.  The Denver Post captured the event in pictures. Please visit the article to see all the photos.

• Omni Eye Specialists – Providing treatment and surgical options for all vision conditions including cataracts, premium IOLs, glaucoma, corneal disease, oculoplastics, and retina. We have state-of-the art diagnostics.  All our doctors are fellowship trained in either cornea, glaucoma, plastics and retina. We work closely with your Optometrists who most likely referred you to us.  We will refer you back to your eye doctor when your condition has been treated.   We also provide after hours emergency on call care for patients.We have two main locations:  55 Madison Street, Suite 355 in Cherry Creek, and 2881 South Yosemite Street in Centennial.  We also have additional locations.  Please ask us when you make an appointment.   Call 303.377.2020 to make your appointment.
• Spivack Vision Center^® – Provides laser vision correction, LASIK and PRK, utilizing state-of-the art technology to provide your best personal vision.  We offer complimentary evaluations to determine if laser vision correction is an option for you.  To schedule your appointment, please call 303.SEE.2020.

• Madison Street Surgery Center – Is a state licensed AAAHC Accredited ambulatory surgery center specializing in eye surgeries to include cataract, premium lenses, retinal, eyelid and cosmetic reconstructive procedures.  Our facility is Medicare approved and, as with Omni Eye Specialists, we participate with most insurance plans.

• Madison Street Anesthesia – Provides gentle and specialized ophthalmic anesthetic services for our surgical patients at Madison Street Surgery Center.

Did You Know?

With laser vision correction procedures (LASIK/PRK), the eye is numbed with eyedrops.  There is a lid holder that gently keeps you from blinking.  The need to blink isn’t there because your eye is numb!

Spivack Vision Center^® works with a couple of different financing providers to offer our patients convenient payment plans.  For more information, visit www.spivack.com and click on the “Fees and Financing” tab.

Laser vision correction is not for everyone.  Our doctors will visit with you about your options.  We are not just a “LASIK only” center.

Spivack Vision Center^® Lifetime Commitment is an agreement.  If eligible (and most people are), we agree to retreat your vision at no charge if you agree to have annual eye exams with your eye doctor.  Please contact us at 303.SEE.2020 for more information.

Retinal Surgeries now at Madison Street Surgery Center

We have the (brand new) Constellation Vitrectomy System.  It is the next generation surgical system, with a number of design and performance features that help make the surgery safer and more efficient.  We also have the brand new Zeiss Lumera surgical microscope, which provides superior optics and illumination to prior scopes.  In short, we have created a brand new vitreo-retinal operating theater from the ground up, utilizing the most advanced technology available at every level.  Now our surgeons are able to provide absolutely state of the art surgical care in a more controlled, comfortable environment for the patient at MSSC.  In emergency situations, where time is a factor, our surgeons are only steps away from MSSC which is located on the floor below Omni Eye Specialists in Cherry Creek.  Once a surgical emergency is diagnosed, our retinal surgeons, Miriah Teeter, M.D. and Salil Shukla, M.D., can provide the fastest possible surgical treatment and maximize the patient’s outcome.

Non-modifiable risk factors for disease include genetic susceptibility, race, eye color, female gender, and age. Modifiable risk factors include cigarette smoking, hypercholesterolemia, obesity, chronic exposure to ultraviolet light, and nutritional status[2]. Prevention of disease has been focused on smoking cessation, maintenance of a healthy diet, and vitamin and mineral supplementation.

Cigarette smoking diminishes the body’s antioxidant ability while vitamin and mineral supplementation is focused on increasing antioxidant potential[3]. Oxidative stress on the retina is thought to contribute to the pathogenesis of age related macular degeneration. The Age Related Eye Disease Study (AREDS) was a large-scale randomized controlled clinical trial that sought to evaluate the role of orally supplemented antioxidants in preventing AMD. The study was sponsored by the National Eye Institute of the United States National Institute of Health and published its results in 2001.

The key finding of AREDS is that taking a daily dose of vitamin C (500 mg), vitamin E (400 IU), b-carotene (15 mg), zinc oxide (80 mg), and cupric oxide (2 mg), (AREDS formula) results in a 25% risk reduction in progression from intermediate to advanced AMD after 5 years[4]. The study also found the AREDS formula decreased the risk of significant vision loss by 19% after 5 years. Evidence of an increased risk of lung cancer in cigarette smokers taking b-carotene[5] led to an AREDS smoker’s formulation devoid of b-carotene.

The AREDS formula of oral supplements is not recommended for all patients diagnosed with AMD, but rather those with intermediate stages of disease or advanced disease in one eye. The formula has not been demonstrated to be beneficial in patients with early, nonexudative age-related macula degeneration4. The staging of AMD is based on clinical exam.

Lutein and zeaxanthin are carotenoids which are naturally occurring plant pigments, also located in the macula, that have been studied in the context of AMD for their anti-oxidant potential. An observational epidemiologic study has described a 43% decreased risk of advanced AMD in the cohort of participants with highest dietary intake of carotenoids compared to the cohort with the lowest carotenoid consumption[6]. Another observational epidemiologic study found that women younger than 75 with stable diets high in lutein and zeaxanthin had a lower prevalence of intermediate AMD[7]. Lutein and zeaxanthin are found in dark green, leafy vegetables. Available commercial AREDS formulations also contain lutein with and without zeaxanthin.

Epidemiologic studies have also suggested an inverse relationship between the prevalence of AMD and dietary fish intake[8]. The rationale for this observation is the presence in fish of w-3 long chain polyunsaturated fatty acids. Dietary w-3 fatty acids components are found in high concentration in retinal photoreceptors and cannot be synthesized endogenously by humans. A meta-analysis evaluated the role of dietary w-3 fatty acids in the prevention of AMD. The study found bi-weekly fish intake was associated with a decreased risk of early and advanced AMD8. However the authors did not feels the evidence was strong enough to support broad prophylaxis against AMD with w-3 fatty acids.

In consideration of the numerous observational studies regarding nutritional supplementation in AMD and the relative lack of randomized case controlled derived data, the Age Related Eye Disease Study 2 (AREDS 2) should provide further direction for patients and practitioners. The study is a multicenter randomized trial evaluating lutein, zeaxanthin, and/or w-3 long chain polyunsaturated fatty acids (docosahexaenoic acid and eicosa-pentaenoic acid) dosed daily, on the progression to advanced AMD. The original AREDS formula will also be reassessed in AREDS 2 by the elimination of b-carotene and a lower dose of zinc8. The results of AREDS 2 are anticipated in 2012.

Current recommendations for patients diagnosed with age-related macular degeneration include smoking cessation and low-fat diets rich in green leafy vegetables and fish. There is not substantial evidence to support nutritional prophylaxis against AMD in the general population, but patients may consider diets rich in green leafy vegetable and regular intake of fish, given their ancillary health benefits unassociated with AMD. Decisions regarding AREDS formula supplementation should be made in consultation with a retina specialist.

References:

1. Congdon N, O’Colmain B, Klaver CC, Klein R, Muñoz B, Friedman DS, Kempen J, Taylor HR, Mitchell P; Eye Diseases Prevalence Research Group.―Causes and prevalence of visual impairment among adults in the United States.‖ Arch Ophthalmol. 2004 Apr;122(4):477-85.
2. FG Holz and RF Spaide. Medical Retina. Springer 2010.
3. Age Related Eye Disease Study Research Group (2000). Risk Factors Associated with Age Related Macular Degeneration. AREDS Study Report  Ophthalmology. 107:2224-32.
4. The Age-Related Eye Disease Study Research Group. A randomized, placebo-controlled, clinical trial of high-dose supplementation with vitamins C and E, beta-carotene, and zinc for age-related macular degeneration and vision loss. Arch Ophthalmol 2001; 119:1417–143
5. Hammar S et al. Risk factors for lung cancer and for intervention effects in CARET, the Beta-Carotene and Retinol Efficacy Trial. J Natl Cancer Inst. 1996 Nov 6;88(21):1550-9.
6. Seddom JM, Ajani UA, Sperduto RD, et al. Dietary carotenoids, vitamins A, C, and E, and advanced age-related macular degeneration. Eye Disease Case – Control Study Group. JAMA 1994; 272:1413–1420.
7. Moeller SM, Parekh N, Tinker L, et al. CAREDS Research Study Group. Associations between intermediate age-related macular degeneration and lutein and zeaxanthin in the Carotenoids in Age-related Eye Disease study (CAREDS): ancillary study of the Women’s Health Initiative. Arch Ophthalmol 2006; 124:1151–1162.
8. EY Chew et al. ―Nutritional Supplementation for Age Related Macular Degeneration‖ Curr Opin Ophthal. 2010;21:184-89.
9. Chong EW, Kreis AJ, Wong TY, et al. Dietary omega-3 fatty acid and fish intake in the primary prevention of age-related macular degeneration: a systematic review and meta-analysis. Arch Ophthalmol 2008; 126:826–833.

Though rare, there are some potential complications that can occur with the microkeratome, such as the risk of a partial flap, hole in the flap, and other flap complications. A flap created using a microkeratome blade can sometimes make the flap thinner in the center and thicker on the edges. There is also a wide variability in the thickness of the flap. This thickness is often unpredictable ranging from 90 microns to 180 microns with the same instrument.

There are several plate thickness selections such as 90, 160 and 180 microns – but each have variability as to the depth of the incision. The amount of suction applied to the eye also had an effect on the depth of the incision. This variability made it difficult to predict if a flap would be too thick or too thin. In some patients with a thin cornea, if a thick flap was made – surgery may need to be aborted, as there wasn’t enough residual thickness to proceed with the surgery. New advances in laser technology now allow the surgeon to use a laser to create the flap instead of the microkeratome blade device. This new technology is called the Femtosecond laser. (Nd:Glass) 1053 nm (near infrared) laser 60hz. The laser places millions of gas bubbles into the cornea at the rate of a femtosecond. One femtosecond equals one billionth of one millionth of a second; or 0.000000000000001 seconds. For context, a femtosecond is to a second, what a second is to about 31.7 million years. As millions of gas bubbles are placed into the cornea at a specific depth they expand and separate the collagen fibrils of the stromal layers in the cornea, thus creating a flap incision. The entire flap is created in 8-12 seconds.

The advantages of laser technology compared to the blade is as follows:

Intralase IFS femtosecond laser

• Patient no longer has “fears” of a blade cutting on the eye
• Only flap creating technology that allows customized parameters
• Makes a consistent flap approx 110 microns thick every time
• Variability on flap thickness only 10 microns
• Less IOP/suction on the eye
• More corneal edema first few days
• Less risk of complications
• If suction loss – can re-applanate and start the procedure over
• Easier for patients with a small palpebral fissure

Microkeratome

• Makes a thicker flap that varies from 90 to 180 microns
• Meniscus flap, thicker at the edge thinner centrally
• Faster than IntraLase
• Higher IOP during the procedure than the IL
• Risk of buttonhole if suction loss
• May need to switch to PRK with a small palpebral fissure

Benefits of Intralase

• Increased quality of vision
• Reduced enhancement rates
• Faster recovery in corneal sensitivity may lead to an earlier reduction of postop dry eye
• Reduction of higher order abberations
• Reduction in most serious, sight-threatening flap complications
• Consistently creates precise, accurate corneal flaps
• Femtosecond technology has revolutionized LASIK surgery and is far more superior to the mechanical microkeratome flap technology.
• IFS technology has taken flap technology to an even higher level with safer, faster, more precise flaps, a smoother stromal bed and it offers increased flap stability with the customized flap edge.

We are pleased to be one of only a few practices in the state of Colorado to offer the newest IFS – Femtosecond laser flap technology to our patients. We believe that blade free LASIK is becoming the standard of care and most patients choose this technology over the microkeratome. You can learn more about blade free LASIK surgery by going to our website at www.spivack.com.

Vandi Rimer, O.D.

Subsequent venous stasis leads to increased transmural vascular pressure and vascular permeability. Intraretinal hemorrhage ensues. Diagnosis of acute BRVO includes observation of intraretinal hemorrhage distal to the site of the arterial-venous crossing. Central retinal vein occlusion involves venous thrombosis proximal to the insertion of the central retinal vein into the eye. Risk factors include systemic hypertension, diabetes, and glaucoma[3]. Hypercoaguable diseases, blood dyscrasias, and vasculitis have also been associated with CRVO. Increased venous pressure distal to thrombosis of the central retinal vein leads to diffuse intraretinal hemorrhage, retinal edema, and variable amounts of retinal ischemia. The clinical sequelae of BRVO include spontaneous visual recovery, persistent macular edema (the macula is anatomic part of the retina encompassing the highest concentration of cone photoreceptors, responsible for fine visual acuity), and/or rarely ischemia associated with retinal neovascularization and possible vitreous hemorrhage. In contrast to BRVO, CRVO is less likely to spontaneously resolve and more often associated with retinal ischemia, retinal neovascularization, and vitreous hemorrhage. Imaging modalities such as optical coherence tomography (OCT) and intravenous fluorescein angiography (IVFA) may be used to quantify the degree of edema, ischemia, and neovascularization.

Visual decrease post vein occlusion is primarily caused by edema involving the macula. The standard of therapy for macular edema associated with BRVO, established by the Branch Vein Occlusion Study Group in 1984[4], has been observation followed by macular laser if poor vision secondary to retinal edema persists. Macular laser increases vision by approximately two lines (on the eye chart) in 2/3rd of treated patients versus a similar visual improvement in 1/3rd of untreated patients. The Central Vein Occlusion Study established that macular laser does not improve vision loss caused by macular edema post CRVO[5].

There are no treatments for CRVO induced macular edema supported by randomized controlled clinical trials. The off-label use of intraocular steroid injection decreases the macular edema associated with vein occlusion, but the results are temporary and the treatment can have serious adverse ophthalmic sequelae including cataract and glaucoma[6].

In the last year two new therapies for macular edema post vein occlusion have earned FDA approval. OzurdexÓ is a biodegradable intraocular implant that slowly releases dexamethasone over the course of three to six months. By three months visual acuity improved by 3 3 lines in 2030% of patients treated with Ozurdex versus 8-14% treated with sham injection. Visual improvement also occurred more quickly in the treatment cohort[7]. However, the visual improvements lasted three months. The incidence of glaucoma and cataracts remained relatively low.

Ranibizumab (LucentisÓ) is a monoclonal antibody fragment with antiangiogenic properties caused by inhibition of vascular endothelial growth factor (VEGF). Serial intraocular injection of Ranibizumab is currently the standard of care for exudative age related macular degeneration. Recent studies have demonstrated the efficacy of Ranibizumab in treating macular edema caused by BRVO[8] and CRVO[9]. At six months serial injection of Ranibizumab resulted in a 3 3-line improvement in visual acuity in 55-61% of patients with macular edema after BRVO, versus 29% of control patients. Similarly, at six months serial treatments with Ranibizumab resulted in a 3 3-line improvement in visual acuity in 44-47% of patients with macular edema after CRVO, versus 17% of control patients. Serious adverse events associated with repeated intraocular injections include retinal detachment and endophthalmitis, though the incidence of these events is exceedingly rare. It is possible that continued injections are necessary to maintain visual gains.

Unilateral acute loss of vision requires urgent evaluation by a vitreoretinal specialist to rule out surgical and medical emergencies. In the context of venous occlusive disease newer treatment modalities offer more patients a chance of visual recovery. Once the diagnosis of venous occlusive disease is made the internist and ophthalmologist should endeavor to maximize medical management of associated risk factors. In those patients without typical vasculopathic risk factors a workup for vasculitis, blood dyscrasia, and hypercoaguable states may be indicated.

Salil Shukla, MD, Vitreoretinal Specialist

Article References

1. Ronald Klein et al. “The 15-Year Cumulative Incidence of Retinal Vein Occlusion. The Beaver Dam Eye Study.” Arch Ophthal. Apr 2008.;126(4):513-518.
2. Am J Ophthalmol. 1993 Sep 15;116(3):286-96. Risk factors for branch retinal vein occlusion. The Eye Disease Case-control Study Group.
3. Arch Ophthalmol. 1996 May;114(5):545-54. Risk factors for central retinal vein occlusion. The Eye Disease Case-Control Study Group.
4. Branch Vein Occlusion Study Group. “Argon laser photocoagulation for macular edema in branch vein occlusion. The Branch Vein Occlusion Study Group.” Am J Ophthalmol. Sep 15 1984;98(3):271-82.
5. Central Vein Occlusion Study Group. Evaluation of grid pattern photocoagulation for macular edema in central vein occlusion. The Central Vein Occlusion Study Group M report. Ophthalmology. Oct 1995;102(10):1425-33
6. Sivaprasad S, McCluskey P, Lightman S. Intravitreal steroids in the management of macular oedema. Acta Ophthalmol Scand. 2006 Dec;84(6):722-33.
7. Ozurdex Geneva Study Group. ”Randomized, Sham-Controlled Trial of Dexamethasone Intravitreal Implant in Patients with Macular Edema DuetoRetinalVeinOcclusion.”Ophthalmology June2010;117(6):,Number6,1134-46.
8. BRAVO Investigators. “Ranibizumab for macular edema following branch retinal vein occlusion.” Ophthalmology. 2010;117:1102-12.
9. CRUISE Investigators. “Ranibizumab for Macular Edema following Central Retinal Vein Occlusion.” Ophthalmology. 2010;117:1124-33.