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LASIK studies showed high patient satisfaction

Peter J. McDonnell, MD, William Holland Wilmer professor and director, Wilmer Eye Institute, Johns Hopkins University, Baltimore, noted in the August issue of Eye World that the Patient- Reported Outcomes with LASIK (PROWL) studies showed that 98% of patients were satisfied or very satisfied with LASIK. According to the study 99.5% of patients achieved a visual acuity of 20/20 or better with 76% attaining acuity of 20/12.5 or better. At 6 months 98% of patients were either satisfied or very satisfied. The studies indicated that outstanding results can be achieved with LASIK. http://www.eyeworld.org/article-modern-lasik-by-the-numbers Posted November 1, 2015

Perfluorodecalin allows rapid laser tattoo removal

Brian Biesman, MD reported in Lasers in Surgery and Medicine October issue the use of perfluorodecalin-infused transparent patch for rapid multi-pass Q-switched high fluence laser treatments of tattoos helped eliminate the opaque, white microbubble formed after exposure to laser. This infused patch with perfluorodecalin resulted in more rapid clearance of tattoos during the procedure. Biesman studied 17 subjects with Fitzpatrick skin types I to III. The author noted no adverse effect with the use of the patch. http://news.cision.com/american-society-for-laser-medicine---surgery--inc---aslms-/r/rapid--high-fluence-multi-pass-q-switched-laser-treatment-of-tattoos-with-a-transparent-perfluorodec,c9851697 Posted October 20, 2015

Docking problem for laser cataract surgery reported in European study

Peter Barry, MD reported at the European Society of Cataract and Refractive Surgeons meeting in Barcelona that perioroperative complications were noted more frequent with femtosecond laser-assisted cataract surgery when compared to conventional phacoemulsification surgery. However, when femtosecond laser-specific complications such as inability to dock and various capsular problems were excluded femtosecond assisted cataract surgery did not show more frequent complications. http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B8b1196c3-6ebc-40b3-8d69-f9a717df30bd%7D/ In 2013 Randal Pham, MD reported a combined laser technique in which an incision of the lateral canthus was performed with the CO2 laser (Nidek, Fremont, CA) to provide space for application of the suction device of the laser and thereby prevented complications such as inability to dock the eyepiece. The CATALYS® system (Abbott Medical Optics, Milpitas, CA) used in Pham’s study showed no docking problem and no complication with capsular tear such as incomplete laser capsulorhexis. http://dx.doi.org/10.4236/mps.2013.34027 Posted October 1, 2015

French health system to use CATALYS for laser cataract study

Béatrice Cochener, MD announced at the European Society of Cataract and Refractive Surgeons meeting in Barcelona that the French FEMCAT study the cost-effectiveness of femtosecond laser-assisted cataract surgery almost achieved the 1800 enrollment target and is expected to be completed by midyear of 2016. According to Cochener, this prospective randomized study aims at providing the scientific basis for adoption of the femtosecond laser-assisted cataract surgery (FLACS) within the French health system. Cochener touted that the FLACS has proven so good that it is comparable to hip surgery and superior to knee arthroplasty or defibrillator implantation. Cochener also reported that following a competitive bid involving 5 lasers the CATALYS® system (Abbott Medical Optics, Milpitas, CA) was selected to be the laser used in the study. http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B2cabc372-61b0-46df-9161-530610530186%7D/ Posted September 15, 2015

Laser removal of tattoos

Roy Geronemus et al. at the Laser & Skin Surgery Center of New York compared nanosecond and picosecond laser technology at different wavelengths, 532 nm, 755 nm and 1064 nm. The authors studied 44 subjects (53 tattoos) and concluded that picosecond laser is safe and effective in treating tattoos. They noted that most inks could be removed with the least amount of treatments using a combination of 755 nm and 532 nm. Wavelength 1064 nm would be preferred for tattoos with black ink in darker skin types. Jeffrey Dover et al. also reported that a combination of 755 nm and 532 nm is effective in removing tattoos that contained black, blue, green, red, orange and yellow pigments. Both groups found that the picosecond laser worked well in most skin types. http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Pham reported that the diode laser 810 nm was safe and effective for removal of eyeliner tattoos. Pham’s study was the only study in literature addressing the safety of tattoo removal laser in areas around the eyes. http://www.ommegaonline.org/article-details/Treatment-of-Eyeliner-Tattoo-Using-an-810-nm-Diode-Laser--A-Case-Study-of-Safety-and-Efficacy/329 Posted September 1, 2015

Incidence of pigmentation caused by lasers in Asians

Hirotaka Akita, MD et al. presented their study comparing the incidence of post-inflammatory hyperpigmentation (PIH) in three Q-switched lasers, Ruby, Alexandrite and Nd:YAG. The authors found that the Ruby laser had the lowest incidence of post-inflammatory hyperpigmentation (PIH). The Alexandrite laser, on the other hand, had the shortest duration time for PIH to clear and that the Nd:YAG had the longest duration time for PIH to clear. They also found that subjects with melasma had a higher incidence of PIH and the longest duration to clear. The authors attributed the difference in incidence of PIH and durations of clearance of PIH to the penetration depth and the degree of absorption by melanin and hemoglobin. They also concluded that subjects with melasma were more prone to develop PIH. http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Posted August 15, 2015

Treatment of dark spots using lasers in Asians

Taro Kono, MD et al. at Tokai University, Japan, showed the Q-switched lasers were highly effective in treating solar lentigines in Asians at the 35th American Society for Laser Medicine & Surgery Annual Conference. The authors used a unique Q-switched Alexandrite laser with three different wavelengths set at different pulse durations: 50 nsec, 100 microsec. The authors reported that PIH occurred in 4 patients. No other complication was noted. The authors concluded that Q-switched Alexandrite laser was highly effective in treating solar lentigines in Asians with minimal complication. Henry Chan, MD et al. reported successful treatment of benign pigmented lesions, including lentigines, in a retrospective study of 13 Chinese subjects at the same conference. One subject developed hypopigmentation. No post-inflammatory hyperpigmentation (PIH) was noted in this study. http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Posted August 1, 2015

Home use laser device for wrinkles

At the 35th ASLMS Annual Conference, Zakia Rahman, MD et al., Stanford University, presented their study on the home-use 1440 nm non-ablative fractional laser device in areas around the eyes. The authors reported improvement of wrinkles in 81% at 12 weeks of treatment in a cohort of 45 subjects. The authors also noted that mild redness, stinging, and warm and burning sensation accounted for 99% of all reported adverse effects. The treatments were also well tolerated with the mean pain score of 1.8 out of 10. It is important to note that the device worked in all Fitzpatrick skin types (I to VI). http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Posted July 20, 2015

Laser hair removal for all skin types

Amanda Lloyd, MD, Michael Grave, MD and E. Victor Ross, MD presented their findings on hair removal using the 1060 nm Nd:YAG vacuum-assisted handpiece without anesthesia in all skin types at the 35th ASLMS Annual Conference in Florida. The authors found a 47% reduction in body hair and that the laser was effective in all skin types (Fitzapatrick skin types II to V). Furthermore, there was no burn or crusting side effects from the treatment. The only side effect noted was a small vesicle that completely healed. http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Posted July 1, 2015

Black cataract surgery with FLACS

Jason Jones, MD reported in May 2015 issue of Eye World a case of black cataract, the densest type of cataract being removed by eye surgeons around the globe. According to Jones “the amount of energy and fluid in the eye is considerably greater than in a normal case, increasing the risk of thermal injury and the degree of trauma and edema.” Jones used the femtosecond laser CATALYS® (Abbott Medical Optics, Milpitas, CA) to remove the cataract in this case and noted far less edema (swelling of the cornea) present the next day after cataract surgery. The patient eventually achieved a vision of 20/25. Jones maintained that “a black cataract is never going to be an easy case, but the femtosecond laser certainly made it easier.” http://www.eyeworld.org/article-flacs-simplifies-black-cataract-cases Posted June 15, 2015

2015 Laser YAG capsulotomy survey

In the May 2015 issue of Eye World magazine, Mitch Gossman, MD highlighted the results of his survey of 100 eye surgeons in the US on the topic of YAG capsulotomy. Opacification of the capsule, the natural container of the man-made lens that is inserted into the eye after cataract removal, is the most common development after cataract surgery. Gossman estimated that 20% to 40% opacification of the posterior capsuleoccurred after cataract surgery. The survey showed that the most common method used by eye surgeons for YAG capsulotomy of capsules that contained the Crystalens was the spiral method, in which the laser procedure started centrally and proceeded peripherally until a desired width opening is achieved. This method allowed surgeons to carefully titrate the size of the opening in the posterior capsule when the Crystalens was the intraocular lens used in cataract surgery. http://www.eyeworld.org/article-yag-capsulotomy--part-1 Posted June 1, 2015

Histologic study showed how PIH was prevented

Randal Pham, MD et al. reported a laser technique used to avoid post-inflammatory hyperpigmentation around the eye in Asians after CO2 laser resurfacing (Mixto SX®, Lasering USA, San Ramon, CA) in the April issue of Modern Plastic Surgery. The authors studied 6 subjects undergoing fractionated CO2 laser resurfacing in the areas around the eyes. A seventh subject was enrolled for histologic study. The lack of hyperpigmentation was attributed to a proprietary non-sequential Z-shape pattern of scanning developed by Lasering USA. The use of loupes to assess ablative depth also improved safety during laser ablation. The uniform depth of laser ablation of 0.05 mm of thermal injury within the resurfaced area showed that stacking of scanned pulses was accurate enough to provide consistent depth ablation and yet only minimal injury occurred when compared to the use of laser in continuous wave mode. http://dx.doi.org/10.4236/mps.2015.52002 Posted May 15, 2015

Laser treatment of abdominal striae

Krystle Wang, MD et al. at Thomas Jefferson University reported the use of 1540 nm (IconTM, Cynosure, Westford, MA) and 1410 nm (EmergeTM, Cynosure, Westford, MA) non-ablative fractionated lasers for the treatment of abdominal striae. The authors studied the effects of these two lasers on 10 patients. It was important to note that all patients developed hyperpigmentation of the area treated. The 1540 nm non-ablative laser was noted to be quicker in terms of procedure time than the 1410 nm laser and showed less pigmentary changes. This study was presented at the 35th ASLMS Annual Conference in Florida. http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Posted May 1, 2015

Successful treatment of laser and IPL complications

Jerome Garden, MD et al. reported the successful treatment of laser and IPL complications using a combination of pulsed dye, Q-Switch YAG or long pulsed YAG lasers at the 35th ASLMS Annual Conference in Florida. The authors treated 22 patients presented with post laser or IPL adverse effects: hypopigmentation, scarring, hyperpigmentation, persistent erythema, and tattoo photooxidative darkening. It is important to note that complications caused by lasers can be successfully treated with lasers given that the appropriate lasers and laser settings are used. http://onlinelibrary.wiley.com/doi/10.1002/lsm.22351/abstract Posted April 22, 2015

Use of imager to measure eyebrow lift

Reynaldo M. Javate, MD, FICS, Charlene L. Grantoza, MD and Kathleen Faye N. Buyucan, MD reported in the November/December 2014 issue of Ophthalmic Plastic and Reconstructive Surgery, the official journal of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS), the use of the Canfield Reveal imager in measuring the changes in eyebrow and eyelid crease after radiofrequency treatments. The authors used the Pelleve S5 Generator radiofrequency device to perform eyebrow lifts in 12 patients. The Canfield Reveal imager was found to be useful in documenting the amount of eyebrow and upper eyelid crease elevations. http://journals.lww.com/op-rs/Abstract/2014/11000/Use_of_an_Imaging_Device_After_Nonablative.10.aspx Posted April 1, 2015

Central toxic keratopathy after PRK

In the February 2015 Blog Issue 2 Dr. Jesper Hjorthal, MD, PhD was featured highlighting the advantages of photorefractive keratectomy (PRK) over LASIK. In this issue, an unusual complication from PRK surfaces: central toxic keratopathy (CTK). Central toxic keratopathy is a rare complication that occurs after PRK or LASIK. Steven Safran, MD reported a patient who developed central corneal opacification (haze) and thinning in both eyes 3 days after PRK. This case is the earliest manifestation of CTK ever reported after PRK. Although it took 3 months of hand holding this patient eventually achieved uncorrected visual acuity of 20/20-2 in the right eye and 20/20 in the left eye. Dr. Safran noted that the above-all-do-no-harm is the best approach to treat CTK. According to Dr. Safran “aggressive treatment is neither required nor beneficial.” http://www.eyeworld.org/article.php?sid=7562&strict=&morphologic=&query=steven%20g%20safran Posted March 15, 2015

AMO notifying surgeons of suction loss during FLACS

Today Abbott Medical Optics (AMO) sent out notice to all surgeons who use the CATALYS® System to inform them of the possibility of suction loss during femtosecond laser-assisted cataract surgery during (FLACS). Even though AMO maintained that suction loss during laser treatment for cataract is a remote, low probability event it nonetheless can occur and may result in scoring of the cornea during lens fragmentation with laser. Randal Pham, MD, FACS has addressed this issue of suction loss in his article in Modern Plastic Surgery (MPS) entitled “Combined carbon dioxide laser lateral canthotomy and femtosecond laser-assisted cataract surgery.” In his article, Randal Pham, MD described a laser technique that provides increased surface area for the suction ring, thereby preventing suction loss during laser treatment. Using the CO2 laser Pham incised the lateral canthus, creating additional space for the suction ring. This technique can be applied to any laser procedure that requires the use of suction on the eye to stabilize the eye during laser procedure. http://dx.doi.org/10.4236/mps.2013.34027 Posted March 5, 2015

PRK advantage, dry eye and new treatment

In the November 2014 issue of Review of Ophthalmology, a monthly publication of Jobson Medical Information, Jesper Hjorthal, MD, PhD, clinical professor at the University of Aarhus, Denmark and president of the European Eye Bank Association, reported the use of laser for surface ablation techniques. Dr. Hjorthal described his techniques for PRK (photorefractive keratectomy). PRK was the first type of laser eye surgery for vision correction and is the predecessor to the more popular LASIK procedure. According to Dr. Hjorthal, PRK has advantages over LASIK in many instances that makes it more appealing. These are: 1. No surgical complications associated with creating a corneal flap. 2. No flap fold. 3. No risk of late dislocation of flap. 4. No epithelial growth. 5. No ectasia. 6. A shorter period of dry-eye symptoms. In the same issue of Review of Ophthalmology, John Sheppard, MD, professor of ophthalmology, microbiology and molecular biology at Eastern Virginia Medical School and president of Virginia Eye Consultants in Norfolk, introduced lifitegrast, an emergent eye drops for treatment of dry eye. Lifitegrast inhibits T-cell inflammation by preventing the binding of 2 cellular surface proteins LFA-1 and ICAM-1. Without the actual signal that caused by the binding of these two proteins, the ICAM-mediated T-cell response cannot occur. Lifitegrast is currently in FDA Phase III clinical trials. http://www.reviewofophthalmology.com/content/d/refractive_surgery/i/3076/c/51528/ http://www.reviewofophthalmology.com/content/i/3076/c/51513/

Combined lasers and fillers to treat tear trough deformities

In a recent interview of experts on the topic of treating tear trough deformities by EyeNet Magazine, a monthly publication by the American Academy of Ophthalmology, Wendy Lee, MD, associate professor of clinical ophthalmology and dermatology at Bascom Palmer Eye Institute, reported that she used a variety of modalities to treat tear trough deformities including the use of laser to improve skin texture. Robert Goldberg, MD, professor and chief of orbital and ophthalmic plastic surgery at UCLA’s Jules Stein Eye Institute, agreed with Dr. Lee. According to Dr. Goldberg, “if you use a filler on a patient with poor skin quality, you don’t get the best effect, and the filler actually makes the skin look worse.” Dr. Goldberg emphasized that both skin quality and skin tone are the most important features in periorbital rejuvenation and are even more important than the orbital rim hollow itself. http://www.nxtbook.com/aao/eyenet/november2014/index.php#/28 Posted February 1, 2015

Periorbital PIH after fractional CO2 laser resurfacing in Asians

Randal Pham, MD, Ingerlisa Mattoch, MD and Sterling S. Baker, MD presented their works on periorbital post inflammatory hyperpigmentation (PIH) at the 2014 California Society of Facial Plastic Surgery Annual Symposium. This pilot landmark study of 6 subjects addressed one of the most common side effects of laser resurfacing in Asians. This unique study not only examined the technique used to prevent PIH but also provided histological evidence for the advantage of the use of fractional CO2 laser in Asians. According to Randal Pham, MD, principal investigator of the research, “Fractional CO2 laser will continue to play a crucial role in facial plastic surgery and this study will help elucidate what factors contribute to safety measures when CO2 laser is used in Asians.” http://dx.doi.org/10.4236/mps.2015.52002 Posted January 15, 2015

2015 Designated International Year of Light

The United Nations General Assembly 68th Session has proclaimed that 2015 is the International Year of Light. This proclamation has great impact on the laser industry. The European Physical Society applauded the proclamation: “In proclaiming an International Year focusing on the topic of light science and its applications, the United Nations has recognized the importance of raising awareness of how light-based technologies sustainable development and provide solutions to global challenges in energy, education, agriculture and health.” The American Society for Laser in Medicine and Surgery will assist the global community in raising awareness about the IYL 2015 and the benefits light-based technologies offer the medical profession. For more information on the International Year of Light and Light-Based Technologies (IYL 2015) email light@eps.org or visit www.eps.org/light2015

Surgeon Looks at Titratable, Adjustable LRIs

NEW YORK — Using a femtosecond laser to create limbal relaxing incisions that are "titratable" is an idea offered by a presenter here.  "LRIs — the ability to treat astigmatism — is the No. 1 rate-limiting factor that keeps many ophthalmologists away from the premium IOL channel," Eric D. Donnenfeld, MD, said at OSN New York 2011. The entire article available at: http://www.osnsupersite.com/view.aspx?rid=89718Posted on the OSN SuperSite November 21, 2011

ARVO: Cataract - Pushing for the Perfect Procedure

As another new technology aims to improve cataract surgery's safety, refinements in technique and lenses reflect continuing advances.  Cataract surgery enjoys a well-deserved reputation as one of the safest surgical procedures in medicine. Yet every year, it seems, there is a new technology, another innovation or a new approach to an old issue that pushes the envelope toward even greater safety and efficacy. This year’s ARVO abstracts continue that tradition. (Unless otherwise specified, these studies had no commercial support.)Entire article available at: http://www.revophth.com/content/d/features/i/1494/c/28025/Mark H. Blecher, MD, Chief Medical Editor, Review of Ophthalmology, 5/2/2011Dr. Blecher is in private practice in Philadelphia. He is the co-director of the Cataract Service at Wills Eye Institute and the founding chief medical editor of the Review.Association for Research in Vision and Ophthalmology (ARVO)

Refractive Surgery

Femtosecond LRIs can be a huge step above manual LRIs and can provide faster, safer, easier, customizable, adjustable and fully repeatable arcuate incisions. from OSN SuperSite November 21, 2011 The entire article is available at: http://www.osnsupersite.com/view.aspx?rid=89718

Refractive Surgery Technology Advances May Expand Options for Surgeons, Patients

OCULAR SURGERY NEWS U.S. EDITION September 25, 2011 US surgical trends in refractive error correction have vacillated substantially over the years, with surface ablation and LASIK gaining and losing popularity as new drugs and technologies emerge. Enhancements that reduce postoperative pain and haze led to a resurgence in the use of surface ablation procedures; topical NSAIDs, topical dilute anesthetics and oral medications ease recovery, and intraoperative mitomycin C lessens visual complications. However, the advent of femtosecond laser platforms for LASIK again turned the tides, improving the precision and safety of a procedure that began to lose popularity amid concerns over potential flap complications. The entire articles is available at: http://www.osnsupersite.com/view.aspx?rid=87879.

Technology Continues to Improve, Advance for Femtosecond Laser-Assisted Cataract Surgery

CATARACT SURGERY - OCULAR SURGERY NEWS U.S. EDITION October 25, 2011 The landscape of cataract surgery is evolving as a significant technology — femtosecond laser-assisted cataract surgery — quickly takes shape, studies unveil promising results and competition develops across the globe. Femtosecond laser technology provides greater precision compared with manual techniques in cataract surgery and may be better for patients overall. It allows physicians to create a precise and centered capsulotomy for improved IOL placement and fragments the lens for less invasive removal. However, with this evolving technology comes the challenges of U.S. Food and Drug Administration approval, competing technologies, availability, and cost to the practitioner and patient. The entire article is available at: http://www.osnsupersite.com/view.aspx?rid=88704

Study Evaluates Mechanisms of Fractional CO2 Laser on Burn Scars

Grapevine, Texas — Preliminary results of a study evaluating biopsy specimens obtained from mature burn scars pre- and postfractional CO2 laser resurfacing show histologic changes that are consistent with the clinical improvement achieved, but further data is needed to understand the mechanisms leading to normal skin regeneration, reported David M. Ozog, M.D., at the 2011 annual meeting of the American Society for Laser Medicine and Surgery. Dr. Ozog, director of cosmetic dermatology, division of Mohs and dermatological surgery, Henry Ford Hospital, Detroit, conducted the clinical portion of the study while doing a Mohs and cosmetic surgery fellowship with Ron Moy, M.D., at the Moy-Fincher Medical Group in Beverly Hills, Calif. The study enrolled 18 patients with mature burn scars defined as more than one year elapsed since the injury.  Key Points is: •    Researchers say understanding immunohistochemistry of effects of fractional CO2 laser treatment on burn scars could lead to development of new drug targets The entire article is available at: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=745033Written by:  Cheryl Guttman Krader.  Ms. Guttman is a medical writer based in Deerfield, Ill.Published in Dermatology Times, November 1, 2011

Mayo Clinic Study Warns of IOP Rise in Some Lucentis Patients

Two major drug trials conclude there was little risk from the AMD drug Lucentis (ranibizumab). Yet a Mayo Clinic ophthalmologist began to note something concerning in some of her patients: an increase in pressure inside the eye. It led to a retrospective study and findings that was presented at last month’s American Academy of Ophthalmology meeting.  Sophie Bakri, MD, had been treating patients in her clinic with FDA-approved ranibizumab, when she began noticing a change in some patients. “I was treating patients and measuring pressures, and I was surprised to see that in some of these people, their intraocular pressure was higher, and they didn’t have a diagnosis of glaucoma,” Dr. Bakri says. “So, why did the pressure go up? Was it from the drug itself, or the actual injection? Is this real? You don’t know if it’s a fluke unless you go back and look at the clinical trials. I took a closer look at the pooled data.” Entire article available at: http://www.revophth.com/content/d/review_news/i/1688/c/30881/

Demand for OTC Laser and Light Devices Continue to Grow

Demand for OTC Laser, light devices continue to grow.  The Dermatology Times in its August 2011 edition noted the following: •    PaloVia, released earlier this year, is an at-home device for reducing periorbital wrinkles•    Silk'n hair removal system has FDA clearance for at-home permanent hair reduction•    Several low-level lasers are cleared for OTC use in the United StatesProducing home devices introduces a challenging balance between efficacy and safety. Safety issues include those for the treatment area, as well as for the eyes. Some device fluences even have been changed post-introduction due to concerns over the retinal hazards. The entire article is available at: http://www.revophth.com/content/d/review_news/i/1688/c/30881/Written by Joely Kaufman, M.D.Dermatology Times

Use of Silicone Sizers in Implantation of Porous Polyethylene Nasal Dorsal Implants in Asians

Abstract Introduction.  A new technique of implantation of high-density porous polyethylene nasal dorsal implants in Asians is described in this paper. Silicone sizers, which have smooth surfaces, were used to facilitate implantation of porous polyethylene implants in Asian patients. Materials and Methods. Twenty-three patients of Asian descent underwent dorsal augmentation rhinoplasty with open technique using high-density porous polyethylene implants. In all cases, silicone sizers were used to facilitate implantations of high-density porous polyethylene nasal dorsal implants. Patient selection criteria exclude patients with history of cocaine use, history of nasal or sinus disorders, previous nasal surgery, deviated septum, poor cartilage support, and thin skin. Results. No bleeding, infection, rejection, displacement, or extrusion was noted. One implant was removed because of a patient's dissatisfaction with the resulting tip height.  Conclusion. The use of silicone sizers to facilitate implantations of high-density porous polyethylene nasal dorsal implants was safe and efficacious. http://www.hindawi.com/journals/psi/2011/606941/

Retinal Evaluation After 810 nm Dioderm Laser Removal of Eyelashes

Abstract background. When operating hair removal lasers on the face or in the periorbital region, even with an ocular shield in place, patients often report seeing “flashing lights” each time the laser is fired. This phenomenon suggests stimulation of retinal photoreceptors and raises laser safety issues. objective. To perform retinal electrophysiologic studies to evaluate the safety of hair removal lasers in the periorbital region. methods. Five patients with severe trichiasis secondary to trachoma were studied. The 810 nm Dioderm laser (Cynosure, Inc., Chelmsford, MA) was used to treat the eyelash follicles on the lower eyelid of each patient. Cox III metal eye shields (Oculo-Plastik, Inc., Montreal, Canada) were placed behind the eyelids of both eyes during the laser procedure. Prior to irradiation, a comprehensive ophthalmic evaluation including pupillary and slit-lamp examination, funduscopy, and full-field electroretinograms (ERGs) was performed. A comprehensive ophthalmic evaluation including ERG testing was repeated 30 minutes and 3–6 months after completion of treatment. An independent blinded assessor evaluated the ERG studies. Subjective reports of laser light sensation, pain, and discomfort during and after the laser procedure were also assessed. results. There was no detectable change in slit-lamp, pupillary, or funduscopic evaluations after periorbital laser irradiation. Similarly the pre- and posttreatment ERGs were unchanged. Three patients reported seeing flashing lights during the procedure. conclusion. We found no ERG evidence of retinal damage after laser hair removal in the periorbital region, with Cox III-type ocular shields over the eyes, even when patients subjectively reported “flashing lights” during laser irradiation. http://www3.interscience.wiley.com/journal/118959873/abstract

Seeing is believing

Just ask Tung Phan, an electronic designer at the Stanford Linear Accelerator who recently underwent a spectacular lens implantation surgery at O’Connor Hospital. Tung, 47, spends eight hours a day at his computer, so he noticed immediately when his left eye began to fail him. “A cataract started forming on my eye about one year ago,” he said. “It worsened quickly, and about two months ago I had only 10 percent vision in my left eye." Tung’s physician referred him to Randal Pham, M.D., ophthalmologic surgeon at O’Connor Hospital. Days later, Tung experienced one of the biggest breakthroughs in cataract implantation technology in the last decade.“This delicate surgery, called intraocular lens implantation (IOL) is designed to provide patients with a full range of vision, from near to far, for the rest of their lives,” said Dr. Pham, an innovator in cataract surgery. Since its inception in the early 90s, IOL has benefited more than 60 mil-lion patients with cataracts worldwide. Anesthesiologist Larry Sullivan, M.D., (left) and Dr. Randal Pham work with a team of excellent nurses. From left to right: Liz Montelibano, Terry Kuhn, and Tess Sanchez. Dr. Pham envisions a world without glasses. He was the first physician in northern California to perform this surgery, which is a step beyond the popular surgery we know as Lasik. “This revolutionary technology addresses the middle age problem of blurry vision up close, whereas Lasik can only correct distance vision.” According to Dr. Pham, this is one of the safest procedures performed in the U.S. today. The human lens is made up of mostly water and protein. The protein lets light pass through and focus on the retina. Sometimes, some of the protein clumps together and starts to cloud a small area of the lens. This cloudy area in the eye’s lens is called a cataract. As we age, the cataract grows larger, making it hard to see. Using instruments the size of a strand of human hair, Dr. Pham and his specialty-trained nurse look through a microscope as they directly implant a lens on the eye of their patient. Making a tiny incision less than three millimeters, Dr. Pham gently rotates the lens using the “Pham hook” (named after him!) so he can remove the cataract and then suction it out. Via the same tiny incision, a new intraocular lens is placed in the eye, unfolded and set into permanent position. Dr. Pham’s patients come from all walks of life. Normally within a day, his patients can go back to their daily activities, with a bright future ahead of them. Reprinted with permission from the July 1, 2005 O'Connor Hospital Insight Newsletter (OCH 07 01 05.pdf)

Crystalens

Crystalens http://www.crystalens.com is a new state-of-the-art lens for cataract replacement that works naturally with your eyes' muscles to give you the quality of vision you enjoyed when you were younger. It works by using the eye's muscle to move the lens backwards and forwards naturally in response to the brain's desire to see at different distances and enables patients to focus through a full range of vision.  Persons best suited for this lens aged 50 years of age and older with cataracts who want to restore their near, intermediate, and distance vision. The medical procedure to implant Crystalens is the same safe, proven cataract surgery performed in over 65 million cataract procedures in the US in the last 25 years and typically takes less than twenty minutes in an outpatient surgical facility. Because the opening into the eye is so small, it heals quickly on its own, without any need for stitches. The United States Food and Drug Administration (USFDA) CrystaLens™ Model AT-45 Accommodating IOL - P030002approved Crystalens in 2003 as an artificial lens to correct the visual impairment of aphakia after cataract surgery. People who have had prior corneal refractive surgery such as LASIK http:// http://www.lasikinstitute.org/ are acceptable candidates for Crystalens implantation as long as their eye is in good health.  Patients should consult their doctors. Dr. Pham is certified to perform surgery using Crystalens and is accredited by the Accreditation Association for Ambulatory Health Care, Incorporated http://www.aaahc.org/eweb/StartPage.aspx

AcrySof® ReSTOR®

The United States Food and Drug Administration (FDA) recently granted approval to Alcon Inc, the world’s leading eye care company, for an intraocular lens called AcrySof® ReSTOR® as an alternative to eye-glasses. This innovative intraocular lens (IOL) is intended for cataract patients with and without presbyopia. It uses a revolutionary apodized diffractive technology to give patients a full range of quality vision (near, intermediate and distance) that greatly increases their independence from glasses after surgery. The clinical studies supporting the approval showed that 80 percent of patients who received the AcrySof® ReSTOR® lens did not use glasses for any activities after cataract surgery. The clinical results also showed that 84 percent of patients who received the AcrySof® ReSTOR® lens in both eyes achieved distance visual acuity of 20/25 or better and near visual acuity of 20/32 or better without correction by contacts or glasses while only 23 percent of the conventional or monofocal control group achieved this level. Near visual acuity of 20/32, or J2, means patients can read the very small stock quotes in the newspaper. “Approval of the AcrySof® ReSTOR® lens is a significant event for Alcon that validates the extensive development work we have done to make it the best lens possible for all of a patient’s vision needs,” said Cary Rayment, President and Chief Executive Officer of Alcon, Inc. The company will begin training surgeons on the lens in April and expects U.S. commercial shipments to begin in May. The AcrySof® brand of IOLs is the most frequently implanted lens in the world, with more than 21 million implants since its introduction in the early 1990s. Alcon, which has been dedicated to the ophthalmic industry for over 50 years, develops, manufactures and markets pharmaceuticals, surgical equipment and devices, contact lens solutions and other vision care products that treat diseases, disorders and other conditions of the eye. For more information on Alcon, Inc., visit the company’s web site at www.alconinc.com. Dr. Randal Pham is the 1st surgeon in Northern California to implant the AcrySof® ReSTOR® brand lens, and according to Alcon he has the most number of AcrySof® ReSTOR® lens implanted in Northern California. Alcon notes that this surgical procedure requires perfect technique, with one step being built on the next step as the building block...which means that if a mistake is made on the 1st step, the 2nd step will not go correctly. Therefore you want to be in the hands of a "perfect" surgeon such as Dr. Randal Pham, because it takes more than the best of the best!

IntraLase

IntraLase is used in LASIK surgery to safely create the corneal flap, the first step in LASIK surgery. Prior to IntraLase, this first step was done manually using a hand-held device with an oscillating metal razor blade, called a microkeratome. Using IntraLase to cut corneal flaps is more user friendly for the surgeon. Making the flap with the laser helps reduce the chance of uneven cuts or collateral tissue damage and improves clinical safety. Precise flap thickness is critical to a successful LASIK outcome, and IntraLase flaps feature a consistent thickness from edge to edge. Flap stability is also an important factor, and IntraLase flaps provide added assurance and peace of mind for many patients. Because of its consistent accuracy, IntraLase may make LASIK a viable option even for patients who previously didn't qualify, such as those who cannot tolerate high suction on the eye. Dr. Pham is one of the first surgeons in Northern California to be certified to use the Intralase femtosecond laser to perform refractive surgery.

Thermage

What is Thermage? Thermage is a cost-effective and non-invasive procedure approved by the FDA that can dramatically reduce the signs of aging with zero downtime and no surgery. The procedure gives the skin a more youthful appearance with no downtime and no surgery. Thermage uses radio frequency which works by heating up the collagen beneath the skin's surface, causing it to thicken and tighten and give the skin a smoother, younger look. How Does Thermage Work? Thermage uses radio frequency energy to tighten up facial muscles. Radio frequency works by heating up the collagen beneath the skin's surface, causing it to thicken and tighten and give the skin a smoother, younger look. Is Thermage Safe? Yes, the Thermage procedure is safe. Although there is always a possibility of skin damage, the Thermage procedure has been studied on many patients and the FDA has approved the procedure for treatment of wrinkles around the eyes. How Long Does the Procedure Take? The procedure can take anywhere from a few minutes to a few hours, depending on the area to be treated. How Long Will the Thermage Results Last? Depending on the individual, the results will last anywhere from about six months to several years. Because each individual is different, you will want to discuss this with your physician. Where Can I Find More Information? There are several web sites with information on Thermage. Two of the most useful are http://www.ncbi.nlm.nih.gov/pubmed/19309652 and http://www.facelift.org/go/facelift/article/thermage.html.

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