Super Vision With The Implantable                  Collamer Lens (ICL)

The Staar Implantable Collamer Lens (ICL) approved for the treatment of myopia since 2006 continues to grow in popularity in the United States and worldwide (over 350,000 lenses placed in eyes worldwide).  This wafer thin lens made out of a novel biocompatible material, Collamer, is placed in the ciliary sulcus on top of the natural crystalline lens.  It is an additive product and unlike cataract removal or clear lens extraction surgery with intraocular lens implantation where the natural lens is removed, nothing is removed with ICL surgery.   

The Visian ICL has proven to be effective in a wide range of refractive errors.   The lens can correct myopia from -3 to -16D and can reduce myopia from -16D up to as high as -20D.  Clinical studies have shown how the ICL is truly a breakthrough myopic treatment in terms of vision correction results.  When higher amounts of myopia are treated with even advanced wavefront driven excimer lasers (both PRK and LASIK), higher order aberrations are induced by the ablation process.   This is not the case with the "additive" ICL procedure. In fact, patients that have had the ICL placed in one eye and laser vision correction in the fellow eye, will often describe their ICL eye's vision as high definition vision vs the lasered eye as their standard definition vision eye.

One of the important advantages of the ICL is that while it can permanently correct ones vision, in the unlikely event that the ICL patient experiences negative side effects after surgery, it can be removed and/or replaced if necessary.  Patients with thin corneas, topographically abnormal corneas and dry eyes, may suffer irreversible consequences with laser vision correction; however are good candidates for ICL surgery which doesn't remove corneal tissue .  If an ICL patient develops a cataract later in life, the ICL lens can be easily removed as it is wafer thin and does not scar down to adjacent tissue.  

At the same time, the cataract can be removed and an IOL can be implanted using the latest technology.  With prior laser vision correction patient's needing cataract surgery, IOL power accuracy can be an issue as the "true" corneal curvature cannot be precisely measured in these patients.

Our experience at Capital Eye Consultants with the ICL over the past seven years has been excellent.  I have performed all my cases at the Fairfax Surgical Center where we have performed cataract surgery for over 25 years.   Patients have one eye treated at a time, with a 2-4 wk wait between eyes (same as cataract surgery).  The surgery lasts about 15 minutes and is performed under topical anesthetic drops and iv sedation administered by anesthesia staff (same as cataract surgery).  Patients return to the office for an IOP check about 2 hrs after leaving the surgical facility and then return for followup the next day, one week and one month later.  Vision return is very rapid with most patients seeing 20/40 or better uncorrected the next day.   At the 2 hr postop visit in the office, many patients are already reading letters on the eye chart they haven't ever seen without correction.  There are opportunities to comanage these patients like our laser vision correction and cataract patients should you desire.  If you have any questions regarding this exciting product, feel free to contact me or Jim Powers.

 John C Baldinger MD

Capital Eye Consultant is happy to offer our referring doctors and their patients a very effective biologic corneal bandage/medical device, Prokera for a host of corneal epithelial healing problems.  Prokera is the only FDA-cleared therapeutic device that both reduces inflammation and promotes healing.  It acts as a biologic corneal bandage for healing without using sutures , and is safe and effective.  

Prokera is a unique treatment that is comprised of cryopreserved amniotic membrane tissue (which has natural therapeutic qualities that help the eye heal faster and with less pain, scarring and less inflammation) secured into a thermoplastic ring set.  It can be used to treat eye diseases such as persistent keratitis, corneal epithelial defects, recurrent corneal erosion, severe dry eye syndrome and corneal burns.  The product is made by clipping a piece of AmnioGraft ® (amniotic membrane) in between two rings made of a clear, flexible, thermoplastic material slightly thicker than an average contact lens. It currently comes in one size (16mm).  It is designed to be self-retaining and to promote wound healing.  

Prokera placement is done in the office and does not require removal for patient monitoring. Healing can be monitored with fluoerescein and it DOES NOT interfere with antibiotic penetration like a bandage soft contact lens.  The FDA approval notes that it may remain in place up to 30 days.  However, most defects in which Prokera is used will see the membrane naturally dissolve in 5-10 days, at which point the ring set can be removed, or earlier if the condition is improved.  If you have any questions or have a patient who you feel will benefit from Prokera, feel free to call any of the doctors at CEC.

               Retinal Implant Gains                                      FDA Approval

The FDA just approved the first retinal implant returning sight to patients with retinitis pigmentosa.  The device is called Argus II, manufactured by Second Sight Medical Products, Inc., and involves an external video "camera" that wirelessly relays information to an internal receiver implanted in the eye.

The device has been used in Europe for several years and the U.S. launch is expected later this year. 

Results are variable, but most patients are able to recognize large objects, negotiate a sidewalk and detect movement. 

The FDA has granted approval as an humanitarian use device (HUD).  Such special approvals are reserved for conditions affecting fewer than 4,000 people in the U.S.  The company must demonstrate that the device is safe and the risks outweigh the benefits.

Retinitis pigmentosa is a rare inherited retinal disease and is associated with dozens of syndromes.  Blindness is not common, but can occur.

Truly exciting news.

Randall V. Wong, M.D.  Retina Specialist
Capital Eye Consultants
www.RetinaEyeDoctor.com

               Laser Vision Correction                                     Update

I continue to perform PRK and LASIK surgery at SeeClearlyVision in Tyson's Corner.  I was the first ophthalmologist in the state of Virginia to be certified and perform laser vision correction back in the 90s.  Since that time, we have performed over 12,000 procedures, co-managing the vast majority of those cases with you. 

The CEC laser program, as in years past, ALWAYS puts the optometrist in the 'driver's seat.'  We have the optometrist set the global fee with CEC and the laser center taking a fixed fee to provide the service.  If the optometrist sets the fee higher, he or she is compensated more.  This is unlike the other models in the area where the O.D. is paid a fixed amount, no matter where the global fee is set.  We feel the CEC model truly empowers the O.D. to control the costs as desired. Capital Eye Consultants has ALWAYS put the optometrist first, and this model continues that tradition.  We are happy to recommend a global fee if you aren't sure where to set that price point.  

All LASIK/PRK consults should be scheduled through CEC.  Please have patients or staff work directly with Litrue Harris.  She will schedule a visit to SeeClearly for wavefront analysis and the consult at Capital Eye Consultants.  I personally see all patients scheduled for LASIK/PRK evaluation and with the wavefront analysis in hand I can determine the surgical plan at that point.  Feel free to call us about the fixed fees involved with our model or any other questions 

John C. Baldinger MD