News and Stories
InSight, the Coastal Eye Specialists newsletter, is mailed to our active patients free of charge approximately three times a year. InSight contains educational information about eye health, as well as news about eye care and our office. If you wish to be added to or removed from the InSight mailing list, please call (805) 983-0700, or e-mail us.
Cataract Surgery Can Boost Dementia Patients’ Functioning
Cataract Surgery Reduces Auto Crashes, Saves Lives
Close Monitoring of Peripheral Vision
Coastal Eye Scores High in National Satisfaction Survey
Dr. Marquez Leads Tri-County Optometrists
Dr. Wan Again Named One of the ‘Best Doctors in America’
Get Your Eyes Screened at Age 40
A Hazard of the Elements
Multifocal Contacts a Good Option for Some, not All, Patients
New Approaches to Treating Glaucoma
‘Now My Eyesight is Unbelievable’
Recycling Old Glasses
Technology Offers Spectacular 3-D Views of Inner Eye
What’s Good for Your Heart Is Good for Your Eyes
Spring 2012 Issue
What’s Good for Your Heart is Good for your Eyes
Skip Hess has thrived on vigorous exercise all his life. In his youth, he was a championship bicycle racer. For years, he competed at the national level in roller dance skating. Now at age 75, he plays tennis three times a week. He moves, thinks and acts like a much younger man.
He has been healthy all his life, and today continues to enjoy vibrant good health overall. In fact, he appears to be a walking advertisement for the benefits of the active lifestyle.
Dr. Lee Wan of Coastal Eye, who has been his eye doctor for several years, thinks Skip provides an excellent example of how regular exercise enhances not only general well-being, but helps protect the health of the eyes as well.
Doctors’ Experience and Research Find Protective Effect
Dr. Wan, himself an avid tennis player and skier, has long recommended the active lifestyle to patients as a means of helping keep their eyes healthy.
“I tell them they should live a healthy lifestyle,” he says. “Most people know what that is. It’s just one more encouragement to do it. I usually tell them that the things they’ve heard are good for the heart and for the brain are going to be good for the eyes, too — exercise, healthy diet,
watching your weight, all those things.”
Dr. Wan observes that regular exercise improves and maintains normal circulation, which is essential to the health of the eyes. “Anything you can do to improve the circulation will not only help reduce hardening of the arteries, but also will improve the health of the eyes and protect them, particularly from macular degeneration and glaucoma. Those are two things that are strongly related to exercise and overall cardiovascular health.”
Two large-scale research studies bear out what he has to say and show just how beneficial the active lifestyle can be for the eyes and vision.
In the Beaver Dam Eye Study, investigators found that subjects with an active lifestyle including regular vigorous exercise were 70 percent less likely to develop the worst form of age-related macular degeneration, the leading cause of severe vision loss in people over 60. The
study was published in The British Journal of Ophthalmology.
More recently, investigators in the EPIC-Norfolk Eye Study in England found that higher levels of physical exercise appear to have a long-term beneficial impact on low ocular perfusion pressure (OPP), an important risk factor for glaucoma. “We believe our study points toward a new way of reducing glaucoma risk through an active lifestyle,” said Dr. Paul Foster, the lead author of the study published in the journal Ophthalmology and Visual Science. “This is a way people can participate in altering their risk of glaucoma and many other serious health problems.”
Dr. Wan also notes there are other ways in which exercise can protect the eyes and vision. For example, exercise helps control blood sugar. Control of blood sugar in diabetic patients dramatically reduces the risk of a serious complication, diabetic retinopathy.
Crystal-clear Vision for Healthy Eyes
Skip Hess is the founder and the former CEO of BMX Products, makers of Mongoose Bicycles. He sold the company several years ago and now owns and manages a large retail shopping center.
He took up tennis about 15 years ago when his wife became interested in the game. Skip and his wife play tennis together and Skip plays regularly with a circle of friends including Dr. Wan. The couple plays tennis with their kids, eight-year-old twins, a boy and a girl. Skip says they’re a tennis family and proudly notes that his son is winning tournaments in his age bracket. He says he and his wife get a sense of satisfaction from teaching their kids the values and fun of an active lifestyle. Keeping up with their kids keeps him young, he says.
About five years ago at his annual eye exam, Dr. Wan told Skip he had early cataracts, but they were not severe enough at that time to recommend surgery. Gradually, Skip began to notice symptoms, which worsened. Trying to serve a tennis ball wearing bifocals was not fun at all, and contact lenses were uncomfortable for him to wear during games. Seeing in diminished
light became more difficult, and driving at night was a tough chore, with halos around oncoming headlights. So in 2009, Dr. Wan gave him a vision questionnaire and a thorough exam and asked him when he would like to have cataract surgery. “Tomorrow if I can,” was his answer.
Dr. Wan recommended Crystalens® intraocular lens implants (IOLs) as being most suitable for his eyes and visual needs. These are presbyopic IOLs, meaning they provide good vision for a range of distances from near to far.
After having worn bifocals for years, Skip is now virtually glasses-free. The only time he wears glasses at all is when he is at his computer for hours at a time, when he dons “cheater” spectacles with a very mild correction.
Skip says the IOLs fit his active lifestyle perfectly. “I couldn’t be more pleased,” he says. “I get up in the morning and go get the paper and sit down and read it. I hadn’t been able to do that for ten years or more. My tennis game is improved, and my attitude is improved. The nice part is I can go through every day and I can see so well. It’s a very rewarding experience.”
Cataract Surgery Can Boost Dementia Patients’ Functioning
“The patient ‘woke up,’ and started participating in his world again.”
— Coastal Eye Surgery Coordinator Anne Miller, C.O.A.
When the light shines through, wonderful things can happen.
That was demonstrated in a recent research study half a world away, and confirmed right here in Ventura County by Dr. Lee Wan, Medical Director of Coastal Eye Specialists.
In a recent study presented at the annual meeting of the American Academy of Ophthalmology, French investigators found that cataract surgery that restores clear vision in patients with mild Alzheimer’s disease can markedly improve their mental function. After surgery, the study subjects showed significant improvement in cognitive capability (the ability to perceive, understand and respond appropriately), and in mood, sleep patterns and other behaviors.
These findings came to life recently for Dr. Wan when he performed cataract surgery that turned out to dramatically transform the lives of two patients.
Alzheimer’s Patient in Remarkable Comeback
One case was a 66-year-old man, a resident of an Alzheimer’s facility, where he was unable or unwilling to participate in daily activities. When the patient was brought into the Coastal Eye office to see Dr. Wan, he was disheveled and unkempt and in a wheelchair. He was withdrawn, inactive and unable to carry on a conversation.
Initially, Dr. Wan questioned the value of doing cataract surgery on him because he did not appear to have enough cognitive function or activity level to justify it. But after consulting with his other doctors, the eye surgeon agreed to proceed.
His initial examination of the man’s eyes revealed that he was virtually blind from dense, almost black cataracts. The density of the cataracts made the surgery difficult, but the procedure went well.
On arriving in the recovery room after surgery, the patient surprised Dr. Wan by telling him what time it was from the clock across the wall. Unexpectedly, he also started making conversation with the nurses in the Recovery room.
Before long, he was recognizing family members who came to visit. His affect completely changed. He smiled, laughed and communicated. He even started reading Sports Illustrated again.
“When we saw him later in the office, he was dressed nicely, was clean shaven, had a fresh haircut and was very animated,” recalls Dr. Wan. “He still struggles with the dementia, but the person is there again. Now that he’s seeing clearly with both eyes, he’s much more active. He has some life again. He’s more independent.”
Reaching for Life Once Again
The second case involved a man in his forties who has been almost completely paralyzed for some 20 years, bedridden, almost completely unable to speak and virtually in a vegetative state. His communication was limited to answering yes or no by blinking his eyes or moving his head slightly. He could make some groaning sounds and he could hear and apparently understand when caregivers read letters to him from his father. Like the Alzheimer’s patient, this man had such dense cataracts that he could see only light and vague shapes. Again, Dr. Wan and the Coastal Eye team, along with the highly trained surgicenter team at St. John’s, took on the difficult case without knowing if it would help.
When he was brought into the Coastal Eye office the next day, his social worker reported that for the first time, he had been able to see the poster on the wall in his room, and for the first time, look at the photos his father had sent him. He was more animated than he’d been in years.
Surgery Coordinator Anne Miller, C.O.A. walked into the room, introduced herself again and asked how he was doing. “He cried, smiled and squeezed my hand,” she recalls. “I cried tears of joy with him.”
When the patient saw Dr. Wan for the first time, he finally managed to form the words, “thank you.”
‘It’s a good feeling…’
When Dr. Wan talks about these patients, his eyes light up. “If you saw these patients when they had their bad cataracts, you’d think their minds had deteriorated so far that they couldn’t function. They couldn’t recognize or interact with other people, so we thought their minds were gone.
“They still face a lot of challenges, but now, after cataract surgery, one of the few things they can do is use their eyes and be able to see their families, and watch TV and take care of themselves a little more. Once they could see again, their level of function was completely
different from what it was before.
“It’s a good feeling to know that what we do can make that much of a difference in people’s quality of life. These were extreme cases, but they highlight the value of vision in maintaining good mental function and well-being.”
Fall/Winter 2011 Issue
Close Monitoring of Peripheral Vision Is Important for Glaucoma Patients
You might call it the eye test that patients love to hate.
Frustrating though it may be for patients to take, the visual field (“peripheral vision”) test continues to prove its value in diagnosing and monitoring eye disease. And now, researchers have confirmed the value of close and frequent monitoring of the visual field in glaucoma patients.
Investigators at UCLA’s Jules Stein Eye Institute found that increasing the frequency of visual field testing leads to the earlier detection of progression (worsening) of glaucoma. The study was published recently in the journal, Archives of Ophthalmology.
Glaucoma, often called “the sneak thief of sight,” is an insidious eye disease that can damage the optic nerve and lead to vision loss and even blindness. The eye pressure is often, but not always, high in glaucoma. One of the hallmarks of glaucoma in its mid to late stages is a gradual diminishing of peripheral vision — defects in side vision. These are often unnoticed by patients until it is almost too late.
Why the Visual Field Test is Invaluable
Visual field testing evaluates the patient’s peripheral vision while looking straight ahead. The detection of defects can confirm the presence of glaucoma, and worsening of the defects over time indicates that the glaucoma is getting worse, prompting doctors to adjust the treatment plan.
Patients taking the test are instructed to push a button whenever they detect spots of light around the periphery of their vision.
When doctors are administering the test, they are looking for vision thresholds. Each point in the peripheral vision has a different threshold, which is the level of brightness at which the spot of light is detected. This normally varies with the position in the field of vision, as well as age and other factors. However, normal ranges for the threshold at each point are known. So when a patient can’t see a light at a particular point until it’s much brighter than normal, it suggests there is a problem in the visual system corresponding to that point.
Or if a glaucoma patient, for example, sees the light at a given point at a certain level of brightness, and then a year later doesn’t see the light at that point until it is much brighter, it suggests that the glaucoma has caused further damage to the nerve over that time.
Not So Simple or Easy
The visual field test sounds simple, but it is not necessarily so. The flashes of light vary in location and in brightness and are difficult to keep up with as they appear and disappear rapidly.
Patients generally do not like to take the test, observes Dr. Lee Wan, Coastal Eye Medical Director. “They tend to get frustrated because everybody who takes the test wants to see all the lights. If you don’t see a light, you think you missed something, you failed or did something wrong. We try to reassure patients that’s not the case. You’re not supposed to see all the lights. You’re supposed to see only the ones above the threshold of your vision at each point. Most patients actually do very well taking the test, even though they might feel they’re not doing the job because they’re not seeing all the lights they think they should.”
Because the loss of peripheral vision indicates that the glaucoma has already caused nerve damage, the test is not the ideal tool to detect glaucoma at its earliest stages, says Dr. Wan. “Ideally we would like to be able to catch glaucoma before the peripheral vision starts to go. But once we start to see defects, we know that the glaucoma is really threatening the vision, and we have serious work to do.”
The recent study, Dr. Wan notes, “reminds us that even though patients dislike the test, frequent evaluation of the visual field is a critical part of catching glaucoma before it gets too far. And if patients will just remember they aren’t supposed to see all the lights, and just relax and do their best, the test is not hard. It can even be kind of fun; kids who play video games get it right away.”
Although visual field testing is employed most often for glaucoma, it is also used to detect, confirm or monitor other conditions that affect the visual system, such as strokes, brain tumors, multiple sclerosis, or drug toxicity. All of these can affect the peripheral vision in characteristic ways, making the visual field an important test in diagnosing and monitoring these patients.
One Tool among Several
Dr. Wan points out that visual field testing is but one method available to monitor glaucoma progression today. The visual field test flags changes in visual function. Doctors also diagnose and monitor glaucoma by looking at the eye’s structure, specifically looking at the health of the optic nerve and watching for signs of damage.
Today, doctors have an incredible technological tool known as the OCT, an advanced imaging device that provides spectacular scans of the nerve and other parts of the eye. The latest-generation OCT used at Coastal Eye uses sophisticated eye tracking to provide an incredibly clear image that can be repeated in the exact same spot each time. So any changes — even subtle ones — in the optic nerve can be detected from scan to scan and help doctors plan the treatment strategy for the patient.
Recycling Old Glasses at Coastal Eye for a Great Cause
Did you know that millions of needy men, women and children in developing nations are pushed deeper into poverty every year by vision problems?
The World Health Organization estimates that 153 million people have uncorrected refractive errors (nearsightedness, farsightedness or astigmatism). Most of these impairments are quickly diagnosed and easy to treat with corrective lenses.
A worldwide humanitarian effort by Lions Clubs International — called Lions Recycle for Sight — is helping meet this critical need so that adults can work productively, children can read and seniors can remain independent. The program recycles used glasses donated by people who no longer need them.
Coastal Eye Specialists collects eyeglasses that patients wish to donate, and turns them over to local Lions Clubs representatives, who pick them up
periodically.
From there, the glasses go to a Lions Eyeglass Recycling Center, where volunteers sort and clean them, determine the prescription and package them for distribution worldwide. While the glasses may not exactly match a third world patient’s prescription, the benefit of having glasses even close to their needs can be life-changing.
“It feels really good to know that we can play a role in helping someone in need, not just with their vision problems but with eyewear,” said Coastal Eye optician Lisa Casas.
Coastal Eye Specialists is currently offering a discount on new glasses with a donation of old glasses in wearable condition for recycling.
New Approaches to Treating Glaucoma 
As promising new surgical procedures become available, eye surgeons today are beginning to take a fresh look at the challenge of controlling glaucoma — the insidious eye disease that can damage the optic nerve and lead to vision loss and even blindness.
One such surgical option is canaloplasty, which is being shown safe and effective and can be offered earlier in the disease process than conventional glaucoma surgery. For many patients, it can replace the need for eyedrops and/or laser treatment, the standard early and mid-stage glaucoma treatments. Canaloplasty carries with it less risk than trabeculectomy, the conventional glaucoma surgery that is usually reserved for the advanced stages of the disease.
“This is a new way of looking at glaucoma surgery,” says Dr. Lee Wan, Coastal Eye’s Medical Director. Dr. Wan has begun to offer canaloplasty to selected patients.
‘The Sneak Thief of Sight’
Often called “the sneak thief of sight,” glaucoma is a leading cause of blindness. The most common type of the disease, called primary open-angle glaucoma, has no noticeable signs or symptoms in its beginning or even mid-stages. Early diagnosis and treatment are essential to minimize or prevent optic nerve damage and consequent vision loss.
For reasons that are not completely understood, increased pressure within the eye (intraocular pressure or IOP) is usually associated with the optic nerve damage — and vision loss — of glaucoma. The pressure comes from a buildup of aqueous humor, a fluid naturally produced in the front of the eye to nourish the tissues. The fluid normally exits the eye through a drainage system. When the drainage system does not work properly, the pressure builds up within the eye and is associated with damage to the optic nerve. So in most glaucoma treatment — including eyedrops, laser and glaucoma surgery — the basic objective is to reduce the pressure within the eye by improving drainage of the fluid. Traditional glaucoma surgery, which involves creating a drain either with a tube or a procedure known as a trabeculectomy, bypasses the normal faulty drainage system to keep the IOP down.
How and Why Canaloplasty Works
With canaloplasty, the surgeon stretches open the eye’s natural drainage canal, which runs around the edge of the cornea. This is where the fluid normally seeps out and is absorbed by the body. Doctors believe that in glaucoma, there is some blockage in this system.
The drainage canal is very tiny, around the size of a hair. The surgeon inserts a tiny catheter into the canal to dilate it and stretch it open. The catheter is then removed and a thin suture is placed to keep the canal stretched open.
With the eye’s natural drainage system opened, the pressure inside the eye is usually lowered. Canaloplasty has helped many glaucoma patients reduce their intraocular pressure and dependence on medications.
“We tell patients that this is almost like angioplasty for the heart,” says Dr. Wan. “If you have a blockage in your heart vessel, they catheterize it and put a stent in there to keep it open. That’s what this is, except that we use a tiny suture to keep the canal open after it’s stretched by the catheter. We think this is safer, just as angioplasty is safer than open heart bypass surgery where a new vessel has to be grafted to bypass the blocked vessel.”
When the Procedure Might be Recommended
Eyedrops have been the gold standard in glaucoma treatment for generations. They remain safe and effective for many patients. But eyedrops are not perfect, Dr. Wan points out. Eyedrops are expensive. They can be inconvenient or difficult for patients to use regularly, especially when multiple drops and complex regimens are required. They tend to irritate the eyes. Doctors are not even sure sometimes that the drops are doing their job consistently around the clock. In addition, several studies have found that a significant minority of patients don’t take the drops as prescribed.
“What’s changing now is that we’re starting to think of these newer procedures such as canaloplasty as something we could do in place of eyedrops rather than waiting for someone who has completely failed with all the glaucoma drops,” says Dr. Wan.
Whether an individual patient is a candidate for canaloplasty depends on a number of issues that must be considered, including personal risk factors, stage and progression of the disease including condition of the optic nerve, etc. As with any surgical procedure, benefits must be weighed against risks.
Dr. Wan says some patients with elevated eye pressure show no evidence of damage to the optic nerve and are best treated non-aggressively with one or two drops. They may do fine with that regimen. “So I wouldn’t necessarily recommend surgery to those patients. But for the patient who is showing signs of damage to the optic nerve and is getting worse, we may offer canaloplasty relatively early on in the process rather keeping surgery as a last resort only, as we used to do with the more invasive traditional procedures.”
Outdoor workers and recreation and sports enthusiasts in Ventura County know all too well how bright sunshine, and dry, dusty, windy conditions can irritate the eyes.
These forces of nature are also implicated in the development of a very common eye condition in this area — pterygium.
A pterygium is a non-cancerous overgrowth of the clear, thin tissue that covers over the white part of the eye, called the conjunctiva. Usually, a pterygium by itself is not vision-threatening. But if it grows too large it can create astigmatism, distort the vision and even block the vision if it encroaches too far across on the cornea. A pterygium usually begins in the corner of the eye closest to the nose and grows toward the center of the eye.
Pterygia are twice as likely to occur in men than women. The growths tend to show up more frequently in certain ethnic populations such as Hispanics, Filipinos, and Japanese, but they can and do occur in anyone. People who are outdoors in the sun a lot, such as surfers and farmworkers, are at high risk. Usually, the first symptoms that prompt a visit to the eye doctor are persistently red, irritated, itchy, swollen eyes.
Some cases will respond to treatment with artificial tears, and sometimes the prescription drop Restasis®, to improve the lubrication of the eye. Dry eyes are a major contributor to pterygia. Patients are advised to wear wide-brimmed hats or caps and sunglasses outdoors and to protect their eyes as much as possible from exposure to irritants such as ultraviolet light, wind, smoke or chemicals.
Medical treatment can often alleviate the symptoms from a pterygium, but does not get rid of the growth. if the patient does not respond to medical treatment, and the growth becomes too aggressive and bothersome, surgical removal is a very effective option.
Surgical Removal of Pterygia
Dr. Lee Wan, Medical Director at Coastal Eye, frequently performs surgery to remove pterygia. Done in an outpatient surgery center, the procedure basically involves peeling the growth off the eye. He also has to remove some of the surrounding inflamed tissue and scar that contributes to the growth.
However, with removal alone, there is a high likelihood that the pterygium will grow back. In fact, in his patient population, Dr. Wan estimates the recurrence rate with simple excision approaches 50 percent. That’s because there is nothing there to keep the pterygium from growing back into the same area.
To prevent regrowth of the pterygium, Dr. Wan places a graft over the white of the eye from which the pterygium was removed.
In most cases, this is an autograft, meaning that the graft tissue comes from healthy conjunctiva from underneath the patient’s own eyelid, which is healthy tissue that is normally protected by the eyelid from the elements.
In some cases, the graft is performed using amniotic membrane. This is typically done for patients who perhaps do not have good tissue of their own to harvest, or if there is another medical reason to avoid using an autograft. This amniotic membrane is healthy donor tissue from a placenta — very thin, clear, non-inflammatory, and quick to heal, much like the conjunctiva itself.
Grafts enable the eye to heal faster and reduce the risk of recurrence. In addition, the surgery can be done using a tissue glue rather than sutures to hold the graft in place while it is healing. “The combination of a graft along with tissue glue and sutureless surgery makes the healing much more comfortable and quick. Usually the patient is back to normal activities in a week or so,” says Dr. Wan.
He estimates that the use of grafts and glue reduces the chance of recurrence to about 5 percent. “Some of the pterygia will grow back no matter what, but the majority won’t,” he says, “especially if the patients protect their eyes and don’t keep doing what they were doing before that made the pterygium develop in the first place. Protection from the sun, wind, and dryness is critical.”
Get Your Eyes Screened at Age 40
Early detection is the best medicine. The earlier doctors catch a sign or symptom of eye disease, the more likely it can be treated effectively, and vision preserved.
That’s why the American Academy of Ophthalmology now recommends that adults, even those with no signs or risk factors for eye disease, get a baseline eye disease screening examination around age 40. This is the time when early signs of disease and changes in vision may start to occur. Based on results of the examination, the eye doctor can recommend the appropriate intervals for follow-up exams.
For individuals at any age with symptoms of eye disease or who are at risk for eye problems — such as those with a family history of eye disease, diabetes or high blood pressure — the Academy recommends a visit to the eye doctor to determine how frequently their eyes should be examined. These recommendations do not replace other visits to the eye doctor to treat ongoing disease or injuries, or for vision testing for eyeglasses or contact lenses.
Around age 40, a number of vision-threatening eye diseases can start to appear. “There are some individuals who never see an eye doctor because they feel they have good vision and have no problems with their eyes,” says Dr. Lee Wan, Coastal Eye Medical Director. “Yet they could have a condition like glaucoma, which doesn’t cause any symptoms at all in its early stages. Or they could have diabetes or other medical problems that could show up in the eye, even when the vision is good.”
Age 40 is also the time when presbyopia — the normal, age-related decline in the ability to focus up close — sets in for most people. “One of our concerns is that if someone is getting blurry vision at that age, we can’t simply assume that they just need reading glasses,” says Dr. Wan. “There’s a possibility they have other eye conditions that need attention. So I think this screening recommendation is a good one.”
2010 |
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