Drs. Bernard and Jonathan Davidorf Provide Eye Care to Indigent
In March, 2013, Drs. Bernard and Jonathan Davidorf traveled to El Fuerte, Mexico, as part of a volunteer medical mission organized by LIGA International,"Flying Doctors of Mercy". The team of physicians, surgical technicians, and local student volunteers treated over 200 needy patients with medical and surgical eye disorders. We hope you enjoy this photo essay detailing the mission.
Dr. Davidorf Returns from Annual ASCRS Meeting
Dr. Davidorf just returned from the American Society of Cataract and Refractive Surgery (ASCRS) Annual Symposium (Chicago), attended by thousands of ophthalmologists from around the world. Dr. Davidorf typically has a rather busy schedule at this meeting, delivering scientific talks/presentations, and teaching courses.
Among his presentations was a report on the functional visual outcomes of cataract surgery patients undergoing implantation with the ReSTOR multifocal lens implant. In the study, Dr. Davidorf found that the vast majority of patients treated with the ReSTOR lens rarely, if ever, needed glasses to drive, use the computer, and read. For the appropriate patient, the ReSTOR lens is an excellent option for cataract surgery patients who are seeking to minimize their dependence on spectacles after their procedure.
Dr. Davidorf also delivered a talk on his results to date with epithelium-on corneal collagen crosslinking (Epi-on CXL). Crosslinking is designed to stabilize the cornea of patients with potentially blinding, unstable corneas from conditions such as keratoconus (or from various surgeries). The goal is to obviate the need for a corneal transplant and allow patients to maintain (or gain) useful, functional vision with glasses or contact lenses. While crosslinking is the standard of care in Europe (and elsewhere), it is investigational in the United States. Dr. Davidorf is performing the crosslinking as part of a multicenter clinical trial. In his report, patients had a rather rapid return of vision, and, while Dr. Davidorf emphasized that the goal of treatment is stabilization of the affected corneas, there were distinct tendencies toward visual improvement as well.
Dr. Davidorf's course, New and Emerging Technologies in Cataract and Refractive Surgery again highlighted rather interesting and unique investigational and newly FDA approved surgical devices and techniques. Dr. Davidorf assembled a panel of renowned eye surgeons from across the US (and Canada) who presented novel approaches to glaucoma surgery, femtosecond assisted laser cataract surgery, corneal transplantation, and astigmatism surgery. Updates on not-yet-FDA-approved lens implants (astigmatism correcting Crystalens, a new small incision lens to correct high levels of nearsightedness, and a light adjustable lens) were also provided.
"Once again," said Dr. Davidorf,"our incredibly insightful and clever group of speakers made the course a great success, and the participation from the attendees was most appreciated. It's a true pleasure to work with such innovative minds."
In his presentation,"The Impact of Capsulorhexis Morphology on Intraocular Lens Implant Power Calculation Predictability", Dr. Davidorf provided supporting data to dispel some commonly held misperceptions regarding cataract surgery. "As cataract surgeons, we are eagerly striving to provide our patients with the best possible vision for the rest of their lives. With that goal in mind, it's important that we identify those factors that do (and do not) impact our outcomes."
Dr. Douglas Koch, this year's recipient of the prestigious Innovator's Award, moderated the session.
Advanced Cataract Surgery Course Draws Young Surgeons
On March 17, 2012, a course in Advanced Cataract Surgery was held at the Marriott Newport Beach Hotel and Spa. Dr. Jonathan Davidorf, a clinical assistant professor of ophthalmology of UCLA, Jules Stein Eye Institute, contributed to the program by instructing residents, fellows and invited members of the ophthalmic community how to successfully perform complex cataract procedures.
The 100 participants came from UCLA, USC, UCI, UCSD, the Naval Medical Center, Loma Linda, Kaiser Permanente, and several private ophthalmology practices. The event sponsor was Bausch and Lomb. A similar course for Basic Cataract Surgery will be held in the Fall.
Creative Approach Provides Excellent Visual Outcome
A patient recently visited our office whose treatment plan required a creative approach due to the condition of his eyes and vision. The patient demonstrated extreme hyperopia (farsightedness of over 11 diopters in each eye) and astigmatism (3.5 diopters in each eye), mild cataracts and rather significant shallowing of the area of the eye where fluid drains out. Patients with farsightedness tend to have shorter eyes, which can crowd this “drainage angle.” If fluid has trouble leaving the eye due to this crowding effect, an acute case of narrow angle glaucoma can result. Rather quickly, these patients can sustain damage to their optic nerve and ultimately lose vision.
Typical treatment of eyes with narrow angles involves either a laser iridotomy (a small laser opening created in the peripheral part of the iris) or cataract surgery. In the case of this patient, cataract surgery could serve a 4-fold benefit of:
- Correcting the patients cataracts
- Creating more space to permanently open the narrow angles
- Correction of the high farsightedness
- Correction of the high astigmatism
The treatment can be performed with “eye drop anesthesia,” and the patient is able to go home the same day. The eyes can be treated within a relatively short time of each other to minimize the severe imbalance that these patients have in the intervening period prior to the second eye being treated.
This patient’s eyes posed one additional problem. While there are several different lens implants for cataract patients which address a variety of vision needs, this patient required an astigmatism correcting (“toric”) lens implant. Due to the magnitude of his refractive error, he needed a toric lens implant with a power of 38D; however, the highest power available is 30D.
To effectively correct this patient’s vision, we put two lens implants in each eye. The lenses consisted of one high power (30D) toric lens and a second (8D) lens placed in front of the first lens to correct the remaining refractive error. This “piggyback” lens technique is not suitable for all eyes. Fortunately, the removal of the cataract created enough space in the eye to allow both lenses to be positioned properly.
Ultimately, this patient is able to see 20/25 at distance without glasses! For the first time in his life he can drive without using thick, heavy spectacles. The toric lens has allowed his quality of vision to improve as well. Another fortuitous result is that he is able to read without glasses, as if his new lens implants are actually adjusting focus like that of a 35 year old. It appears that there is actually some accommodation (changing of focus) with the two lenses that is not typical of single focus lens implants.
Corneal Collagen Crosslinking and Keratoconus
Recently, a patient came in who we treated for keratoconus in December of 2010. Patients with keratoconus develop thin and irregular corneas, leaving them with an irregular form of astigmatism. This type of astigmatism is so severe that it is difficult to correct with glasses or even soft contact lenses. The condition tends to be progressive, and, at times, corneal transplantation is the only option to help restore functional vision.
Over the last few years, there has been data suggesting that keratoconus patients can benefit from a technique called “corneal collagen crosslinking.” The corneal collagen crosslinking procedure involves UV light working in conjunction with photosensitizing riboflavin (vitamin B1) eye drops, with the objective of strengthening the collagen fibers in these structurally weakened corneas. The procedure forms “crosslinks,” creating a more sturdy (and stable) cornea. This technique is not FDA approved.
Currently, Davidorf Eye Group is involved in a clinical trial (link to cxl usa) evaluating the procedure. The above mentioned patient was treated with a combination of photorefractive keratotomy and corneal collagen crosslinking (several months apart) and has seen both a dramatic reduction (near elimination) of her high astigmatism and an improvement in her quality of vision (best corrected vision).
Dr. Davidorf observed, “Examination of her eyes, even under the microscope, does not reveal that any treatment was done, yet she can now see, even without glasses. We are hopeful that corneal collagen crosslinking will provide this patient, along with many others struggling with keratoconus, the cornea stability needed for good vision.”
Age or Prior Surgery Doesn’t Eliminate Possibility of LASIK
Often patients think they are “too old” to undergo LASIK or, perhaps, a previous eye surgery would preclude them from being a good candidate. Just yesterday a 69 year old woman came into the office for her one month postoperative visit after having LASIK in both of her eyes.
What makes her case interesting is that she had previous cataract surgery performed on both of her eyes many years earlier by another doctor. While there were no problems with her cataract surgery, it was done prior to the advent of the specialty multifocal and accommodative lens implants that can allow patients increased freedom from spectacles.
In this patient’s case, she was wearing glasses for both distance and near vision. With LASIK, we were able to correct her nearsightedness and astigmatism, while inducing a monovision effect (correcting her non-dominant left eye for near vision) that enables her to read without glasses.
“After careful evaluation and exploration of our options”, Dr. Davidorf stated, “This patient is now completely glasses free and incredibly happy with her new vision.”
Dr. Davidorf Explores All Options for Great Vision
A history of medical or ocular conditions does not necessarily mean patients can’t enjoy excellent vision. Dr. Davidorf recently performed cataract surgery, implanting a multifocal intraocular lens, for a female patient with a history of diabetic retinopathy in both eyes. Prior to seeing Dr. Davidorf, the patient also had cataract surgery on her right eye. She came to Davidorf Eye Group complaining of decreased vision in both eyes. Dr. Davidorf found that she had developed a visually significant cataract in her left eye, along with some astigmatism, and had a moderate amount of astigmatism in her previously treated right eye. The patient’s retinas showed no signs of new diabetic retinopathy and her blood sugar levels were under control.
The patient clearly needed cataract surgery but also wanted to decrease her dependency on glasses. Typically, ideal candidates for the more advanced refractive surgeries, including LASIK and multifocal intraocular lenses, (which can allow cataract patients independence of glasses) do not have extensive ocular or medical histories. Fortunately, these histories are not necessarily a contraindication to improved vision. Despite her history of diabetic retinopathy, astigmatism, and prior cataract surgery with a standard lens implanted in one eye, this patient was able to achieve an excellent visual outcome with the ReSTOR multifocal lens implant. This lens provides good functional vision, without glasses, for most activities.
"Typically, optimal results with multifocal lenses such as the ReSTOR and TECNIS lenses are achieved when patients have the lenses implanted in both eyes," observed Dr. Davidorf."However, patients can still be good candidates, and reduce their dependence on glasses, with a multifocal lens implanted in their second eye".
The last item requiring attention was the astigmatism in her previously treated right eye. Despite the fact that she had prior cataract surgery, she was an excellent candidate for LASIK. Additionally, the history of well-treated diabetic retinopathy did not contraindicate LASIK.
ReSTOR patients achieve the best vision when their astigmatism is minimized. Dr. Davidorf’s plan was to correct any residual astigmatism with LASIK, once her left eye stabilized following the ReSTOR implant. The patient saw quite well within the first couple of days following the RESTOR surgery. As expected, a small amount of residual astigmatism was present. Since Dr. Davidorf was already planning on performing LASIK in her previously treated (cataract surgery) right eye (the eye with a substantial amount of astigmatism), he was able to perform LASIK on both eyes on the same day.
"The patient has done exceptionally well following the procedures and is able to perform all of her tasks and activities without glasses," Dr. Davidorf stated."As importantly, her eyes remain healthy and display no reactivation of diabetic retinopathy. This should continue as long as the blood sugar levels and blood pressure remain well controlled. We’re both very happy with her visual outcome."
LASIK Can Be An Option For You Too
Dr. Davidorf recently performed all laser LASIK, using the Allegretto Wavelight Excimer Laser, for a patient who was tired of constantly taking her glasses on and off. She was mildly nearsighted with mild to moderate astigmatism, which meant she could see without glasses up close, but was bothered by everything being blurry at distance without her glasses.
When people with low amounts of nearsightedness (myopia) are younger (under the age of 45), they can wear their glasses and see just fine at all distances. After the age of 45 (and most certainly after the age of 50), this ability diminishes. In the case of this patient (53 years old), we were able to treat just one eye, correcting it for the best possible uncorrected distance vision we can achieve. Her other eye, untreated, will enable her to still read without glasses. As a teacher, she should be able to function for most (if not all) of her tasks without glasses. Sometimes these patients will wear a thin pair of glasses to drive at night (ie: in unfamiliar areas, or when it’s raining outside), but, for the vast majority of activities, they remain glasses free.
This patient had one other interesting finding on her preoperative exam. In the center part of her retinas, she has drusen. The drusen are mild, but they do represent a risk factor for the development of macular degeneration. LASIK does not affect one’s risk for developing macular degeneration. In the case of this patient, because her vision (with glasses) before the procedure was very good, LASIK was still a viable option. It will remain important for her to follow-up postoperatively over the coming years (just like she would if she had not undergone the procedure) to have her ocular health monitored.
Points for Patients:
- Patients around the age of 50 years old who hate putting glasses off and on (whether for distance or near) are usually great LASIK candidates
- These same patients often only need one eye treated
- Astigmatism is easily treated with LASIK
- Drusen is a risk factor for macular degeneration that does not contraindicate LASIK
- Patients need to have routine, dilated eye exams to have their ocular health monitored.
Cosmetics and Eye Safety
For millions of women around the world, wearing makeup is a natural part of their day-to-day routine – a quick dab of foundation, a fresh coat of lipstick along with an application of mascara to make the eyes stand out. While many women consider makeup one of their essentials for personal care and beauty, not all of them realize that he the cosmetics require just as much maintenance as they do.
The job of makeup is to make a woman look fresh and radiant. However, if the makeup is causing infections, allergic reactions and injury to the eye, it's doing exactly the opposite of what it is intended for. Eye problems caused by makeup can range from minor irritations to tearing and watering of the eyes, and even loss of vision.
Fortunately, the care of eye makeup is very simple, yet very important, toward maintaining healthy eyes. Below are some cosmetic tips:
Keep Makeup Clean
Always tighten lids and caps of containers after use in order to prevent a breeding ground for bacteria. Also, if cosmetics have fallen on the floor or leaked onto another product, be sure to discard those products to prevent dusty and debris from entering eyelids and lashes.
Never Share Makeup
While this gesture seems harmless, it can actually lead to unfamiliar germs that may be hazardous to the eyes. Also, never use a"tester" product at cosmetic counters that does not have single-use applicators such as sample sticks or cotton swabs.
Keep Still When Applying Makeup
Never apply makeup in the car even as a passenger. If the car were to stop suddenly, hit a bump, etc. there is a strong possibility that mascara or an eye pencil could go into the eye creating a corneal abrasion or worse.
Discard Expired Makeup
All cosmetics should be thrown away every six months to prevent spread of bacteria. Also, always remember to use a fresh applicator when purchasing new products.
When used properly, eye makeup is a great way to accentuate beauty and enhance personal appearance. However, for vision protection and eye care, practice proper maintenance of cosmetic products.
Cataract Patient Aces Table Tennis Championship
Neil Kuluva and Martin Sundel recently emerged as winners of the 70+ Doubles Event at the 2010 U.S. National Table Tennis Tournament in Las Vegas. The win was especially rewarding as they won the California Class A Event forty-five years ago, in 1965.
Both Neil and Marty have had previous cataract surgery. Neil's procedure was with Dr. Jonathan Davidorf, who implanted the Toric intraocular lens to correct Neil's astigmatism and improve his vision. Afterward Neil exclaimed, "See what can happen if you can see! The surgery with Dr. Davidorf and the Table Tennis were great successes."
Hawaiian Ophthalmological Society Features Dr. Davidorf
The Hawaiian Ophthalmological Society recently featured Dr. Jonathan Davidorf as a guest speaker at their annual summer meeting. Dr. Davidorf presented advancements in cataract surgery and intraocular lens implants (IOLs). Multifocal and accommodative IOLs, specifically ReSTOR, Crystalens and TECNIS have proven to be excellent options for cataract patients seeking to reduce or eliminate dependence on glasses. Dr. Davidorf also discussed the astigmatism correcting Toric lens implant. Following his presentation, he participated in a panel discussion with three other leading ophthalmologists from around the United States.
The Hawaiian Ophthalmological Society is dedicated to continuing medical education of its members and promoting fellowship among ophthalmologists in the State of Hawaii. The Society participates in several community outreach programs including the National Eye Care Project and Diabetes 2000.
A frequent guest speaker at local, national and international meetings, Dr. Davidorf is a recognized contributor to the advancements in eye care.
Dr. Davidorf Goes to Washington
Dr. Davidorf was recently invited by the American Society of Cataract and Refractive Surgery to attend a conference in Washington, D.C., where policy issues designed to preserve access to high quality specialty medical care was discussed. The conference was sponsored by the Alliance of Specialty Medicine, a non-profit organization representing 100,000 specialty physicians including gastroenterologists, urologists, neurosurgeons, ophthalmologists, and cardiologists, among others.
Following an extensive day of lectures, discussions, and meetings, Dr. Davidorf attended a hearing of the Energy and Commerce Committee and met with the offices of senators and congressmen, including those of Barbara Boxer, Diane Feinstein, and Representative Henry Waxman.
Of immediate concern was the importance of repealing and permanently fixing the so-called “Sustainable Growth rate” (SGR) formula (it calls for a cut of nearly 30% to Medicare physician payments beginning January 2012) and repeal of the Independent Payment Advisory Board (IPAB), created as part of President Obama’s new healthcare package, which could prove to be more severe than the SGR cuts. Under IPAB, significant authority is delegated to a newly created 15 member board of non-elected, unaccountable officials specifically charged with cutting Medicare. As some specialists have already begun to limit the numbers of Medicare patients they see (or leave Medicare altogether), the fear is that with any further cuts, Medicare patients will begin to seriously feel the impact of limited choices in their specialty medical care.
Support for repealing these two items (SGR and IPAB) is meager on the Democratic side. “It was, quite frankly, a bit disheartening to see how an issue as important as healthcare could be so partisan,” commented Dr. Davidorf.
Other topics discussed included:
- Patient protection
- Fostering medical device innovation
- Medical liability reform
- FDA reform
“I would encourage everyone to educate themselves on these issues and contact your senators and congressmen. Let them know your stories, let them know how you feel. The viability of Medicare and access to high quality healthcare is at stake.”
FDA Approves Additional Toric Lenses
On May 3, 2011, the FDA approved the T6 – T9 versions of the AcrySof Toric Intraocular (IOL) lens for correction of astigmatism. Originally approved by the FDA in 2005, these latest versions of the AcrySof Toric lens can correct up to + 4.5D of corneal astigmatism.
Astigmatism is a common eye condition usually caused by an irregularly shaped cornea. Instead of having a round shape, the cornea is too steep or flat, like a football. As a result, light rays are not focused on one spot on the retina, thus, vision becomes distorted.
Until recently, life without reading glasses or bifocals was not an option for most cataract patients with astigmatism. The AcrySof Toric lens is a technological innovation that provides an enhanced image quality and a full range of vision - near, intermediate and far, and gives patients the opportunity to be free from reading glasses or bifocals. The lens essentially allows surgeons to treat both presbyopia and astigmatism in one procedure.
"Visual outcomes from the Toric lens have been excellent," states Dr. Jonathan Davidorf. "Our patients are ecstatic and continue to benefit from these evolving technological advancements."
Computer Vision Syndrome More Prevalent
Ophthalmologists and optometrists agree that there is too much staring and not enough blinking among Americans and it is resulting in an annoying condition called “computer vision syndrome (CVS)”. This syndrome is not one defined disorder, rather a collection of symptoms that are affecting people young and old who work, study and play in front of a computer monitor. Industry officials believe it is more widespread than repetitive motion injuries, such as carpal tunnel syndrome.
In a recent nationwide survey, 82% of respondents say they frequently use a computer or hand-held device, and 42% frequently use a computer for three or more hours per day. The Journal of the American Optometric Association points out that most people using their computers fail to blink or take enough breaks, have lights too bright and often have their monitors positioned incorrectly. This leads to 75% of the respondents reporting some type of eye problems. The symptoms of computer vision syndrome include; headaches, burning eyes, tired eyes, inability to focus and double or blurred vision.
Tips to Relieve Computer Vision Syndrome
- Get a comprehensive eye exam; Computer users should have annual eye exams. Be sure to tell your eye doctor how often you use a computer.
- Use proper lighting; When using a computer, your ambient lighting should be about half found in most offices. Eliminate exterior lighting by closing blinds and shades. Reduce interior lighting by using fewer bulbs or fluorescent tubes.
- Minimize glare; Glare from walls and finished surfaces can cause eye strain. Consider installing an anti-glare screen on your monitor.
- Adjust brightness & contrast on your monitor; Adjust the display settings so that the brightness of your screen is about the same as your work environment.
- Blink more often; Blinking moistens your eyes helping to prevent dryness and irritation.
- Exercise your eyes; To reduce your risk of eye fatigue, look away from your computer at least every 20 minutes and gaze at an object at least 20 feet away for at least 20 seconds.
- Modify your workstation; Make your workplace ergonomically correct by placing documents on a copy stand adjacent to your monitor. Position the monitor 20-24 inches from your eyes with the center of the screen 10 to 15 degrees below your eyes.
- Consider computer eyewear; Computer glasses may be an excellent option, especially if you wear bifocals or progressive lenses, because these lenses generally are not optimal for the distance to your computer.
PGA Golfer Has Corneal Collagen Cross-Linking for Keratoconus
Playing professional golf for over 11 years, Matt Lane struggled with more that just bunkers and water hazards throughout his career, he also had vision problems. Diagnosed with keratoconus, which causes weak and unstable corneas often leading to nearsightedness and astigmatism, Matt continuously searched for solutions to correct his vision. While a procedure to treat keratoconus has not yet been FDA approved, Corneal Collagen Cross-Linking has gained momentum as a viable treatment.
Dr. Jonathan Davidorf was recently asked to participate in a clinical study for Corneal Collagen Cross-Linking. The treatment is intended to stabilize the cornea and ideally halt the progression of keratoconus.
"Patients treated in the study have responded very well," states Dr. Davidorf."We found that the Corneal Collagen Cross-Linking procedure has not only slowed the progression of keratoconus, but actually improved vision in some patients."
The procedure takes approximately 90 minutes and can often be performed without removing the cornea’s protective epithelial membrane. Patients are given numbing eye drops followed by drops of riboflavin (Vitamin B1) and asked to look into a special UV light source at specific intervals. There is no pain or discomfort and strengthening and stabilization of the cornea takes place over the subsequent several months.
Following his Corneal Collagen Cross-Linking treatment, Mat observed,"I had no discomfort at all. After struggling with vision problems for so long, this may finally be the procedure that enables me to pursue my dream of playing on the Champions Tour."
"The concept of corneal cross-linking has been around for several years," Dr. Davidorf mentions."The specific procedure and technology utilized in this clinical trial appear to be more advanced than those used in similar trials. This may prove to be a significant step in the treatment of keratoconus."
Dr. Davidorf is a frequent participant in clinical trials aimed at advancements in ophthalmology.
Are You Tired of Reading Glasses?
After the age of forty, everyone begins to lose the ability to accommodate or focus the lens of the eye. As we mature, the natural crystalline lenses in our eyes become firm, enlarged and lose their flexibility. This is not a disease or illness, rather a natural occurring event called presbyopia. An indication of presbyopia is when you cannot read without holding the item far away from you. For many, distance vision remains relatively unaffected.
When presbyopia occurs, most people do well with reading glasses, bifocals or progressive lenses. These eye glasses have plus-powered lenses that would normally be worn by someone who has hyperopia (farsightedness); however, the plus-powered lenses can help someone who is presbyopic because these lenses bring the point of clear focus to a comfortable reading distance.
While there is currently no outright"cure" for presbyopia, monovision LASIK is a viable option for people struggling with reading glasses. For many, monovision LASIK will reduce or eliminate the need for readers, bifocals or progressive lenses.
"Many people never require glasses or contact lenses until they reach 40 – 45 years of age and become presbyopic," observes Dr. Jonathan Davidorf."As they reach 45 or 50 years of age, they find it frustrating to continuously have to take their glasses on and off over the course of the day, even to see something like a cell phone. Monovision LASIK is an excellent option for these patients, a way to really turn back the clock."
The concept of monovision LASIK is simple. One eye is corrected for near vision and the other eye is corrected for distance vision. The brain figures out which eye to use and when. The determination of how to achieve monovision is based on the individual's current vision.
If a person has never needed corrective lenses, a small amount of myopia can be induced in that person's non-dominant eye. The dominant eye remains uncorrected as it already provides distance vision. One can determine the dominant eye by raising a thumb, holding it out in front of both eyes, and blocking an object with the thumb while both eyes remain open. Once the object is blocked, close one eye at a time, and the eye that cannot see the object is the dominant eye.
If a person already has less than two diopters of myopia, that person's dominant eye can be fully corrected for distance vision and the non-dominant eye not changed since it already provides good near vision.
People with greater amounts of myopia may have the dominant eye corrected for good distance vision and the non-dominant eye under corrected to less than two diopters for good near vision. Someone already hyperopic may have the non-dominant eye over corrected into myopia and the dominant eye either corrected for distance or untouched.
Before proceeding with LASIK for monovision, some patients, depending on their eyes, can try contact lenses to achieve the effect of monovision. This simulates the results of LASIK.
"Monovision LASIK is not for everyone," Dr. Davidorf states."However, it's common for patients to adapt very quickly and be extremely pleased with their visual outcomes, in addition to no longer struggling with the constant need for reading glasses."
ABC News Features Dr. Davidorf
Dr. Jonathan Davidorf was asked to comment on a petition submitted to the FDA requesting stronger warnings for LASIK laser vision correction. Please click on link below:
Can Vitamins Prevent Cataracts?
In the United States an estimated 20.5 million people over the age of 40 show some evidence of age-related cataract. For 50% of these individuals, the cataracts are significant enough to impair vision. Cataract surgery is common and readily available, however, the procedure accounts for a large portion of Medicare expenditures. Prevention of cataract is a preferred strategy, yet other than avoidance of cigarette smoking, no other preventative agent has been identified.
Nutrition is suspected to play an important role in cataract development. Since oxidative damage is a feature in cataract, nutritional research has centered on antioxidants, particularly vitamins C and E, and the risk of cataract. A clinical trial, featured in the November 2010 issue of Archives of Ophthalmology, examined the effect of these vitamins on the development of cataract. The trial included 11,545 apparently healthy US male physicians 50 years or older without prior diagnosis of cataracts. The participants were divided into two groups. One group was randomly assigned to receive 400 IU of vitamin E or a placebo on alternate days while the other group was randomly assigned to receive 500mg of vitamin C or a placebo daily.
After 8 years of treatment and follow-up, 1,174 cataracts were confirmed in the vitamin E group. Of these, 579 cataracts were found in the participants receiving vitamin E while 595 participants receiving the vitamin E placebo were found to have cataracts. Similarly, 593 cataracts were found in the group treated with vitamin C while 581 cataracts were found in the vitamin C placebo group.
The clinical trial concluded that long term, alternate day use of 400 IU of vitamin E and daily use of 500 mg of vitamin C had no notable beneficial or harmful effect on the risk of cataract development. Ultimately, long-term use of these two vitamin supplements has no appreciable effect on cataract.
Dr. Davidorf Selected for Corneal Cross-linking Study
Dr. Jonathan Davidorf, a frequent contributor to FDA studies and advancements in eye care, has been selected to participate in a study aimed at the treatment of keratoconus. Affecting approximately 1 in 750 Americans, corneas with keratoconus can bulge forward into the shape of a cone causing high levels of astigmatism and poor vision. Often keratoconus patients first require glasses, then contact lenses, and, if the condition progresses in severity, a corneal transplant may be required.
Corneal collagen cross-linking is a procedure that was first introduced in 1998 to treat patients with weak, thin, and irregularly shaped corneas. The objective of the treatment is to slow, if not cease, the progression of keratoconus and ultimately improve vision. By adding"cross-links", the cornea becomes more stable, improving its shape and focusing power. Ideally, these new cross-links strengthen the cornea and stop further vision loss.
The treatment is an outpatient procedure performed in the office. Patients are given numbing drops and a mild sedative. The epithelium, which is the thin layer of tissue covering the cornea, is then removed. Next, vitamin eye drops (riboflavin) are placed in the eye and the patient is asked to look at a soft blue UV light. Depending on corneal thickness, the treatment may be performed without removal of the epithelium. Throughout the treatment, the patient is comfortably reclined and eye drops are used to prevent dryness. The entire procedure takes approximately 90 minutes if both eyes are treated.
"Corneal collagen cross-linking may prove to be an excellent option for individuals struggling with keratoconus," states Dr. Davidorf."Patients have responded very favorably to the treatment, including less discomfort with contact lenses and improved vision."
Dr. Davidorf Completes Surgical Expedition
Dr. Jonathan Davidorf recently completed a surgical expedition to Honduras. Dr. Davidorf has previously volunteered his surgical expertise to impoverished areas of Central America and Africa in need of cataract surgery. Over the course of his visit, he was able to treat dozens of individuals who would otherwise not have received surgical eye care. Dr. Davidorf’s twelve year old daughter, Carolena, accompanied him and offered her support by caring for the patients before and after their procedures and even assisting the surgical technicians with the organization and handling of the instrumentation and lens implants.
Olga Caballero, the medical coordinator in Honduras expressed her gratitude. “We are truly grateful to Dr. Davidorf for volunteering his time and surgical skill. He helped so many of our patients and his generosity is greatly appreciated."
"These people are in desperate need of health care," Dr. Davidorf stated. “I was honored to be asked to return to Honduras to help offer some assistance, and it was particularly meaningful to share the experience with my daughter – she was a fantastic travel partner. We hope to return again."
FDA Approves Device for AMD
The FDA has approved a device that may give patients with end-stage macular degeneration (AMD) a viable option to regain some of their central vision. A pea-sized miniature telescope (Implantable Miniature Telescope) can magnify images in the central blind spot that are typically blocked in end-stage wet AMD or advanced dry AMD. The device is not a cure for AMD, rather it is intended to improve the quality of life in patients who are severely visually impaired. The telescope implant will allow patients to recognize faces, see headlines in newspapers and possibly read large-print books.
The telescope is implanted into the anterior segment of the eye. The patient uses the eye without the implant for peripheral vision. The telescope essentially acts as a low vision aid for patients with end-stage AMD who have no other options for improved vision.
Candidates for the telescope implant must be 75 years or older with severe vision impairment in both eyes due to end stage AMD, and cannot have had previous cataract surgery. Following the procedure, patients must receive rehabilitation with a low vision specialist. In the U.S. FDA Clinical Trials, most patients adapted to using one eye centrally and the other eye peripherally after a period of time.
ASCRS Features Dr. Jonathan Davidorf
This year, ophthalmologists from around the world attended the American Society of Cataract and Refractive Surgery (ASCRS) Symposium in Boston (April 2010). One of Dr. Jonathan Davidorf’s presentations detailed the results of an ongoing prospective study designed to describe the visual function and level of spectacle independence of cataract surgery patients with ReSTOR or Crystalens lens implants. Of the current cohort, there are 98 eyes of 49 patients who underwent cataract surgery in both eyes and received either the ReSTOR D1 (+3D add) or Crystalens HD intraocular lens implant.
Patients were asked to rate their degree of spectacle independence following their procedure. Key activities for which ReSTOR patients reported rarely (if ever) wearing glasses were day driving (93%), night driving (89%), computer use (88%), and reading books (79%). Crystalens patients reported rarely (if ever) wearing glasses for day driving (79%), night driving (68%), computer use (83%), and reading books (83%).
Patients were also asked to rate their satisfaction with the results of their procedure on a scale of one (dissatisfied) to ten (extremely satisfied). The mean satisfaction scores were 8.7 (ReSTOR) and 7.6 (Crystalens).
The results document a high degree of spectacle independence in both groups. It is important for patients to understand that, while complete spectacle independence is the goal, reasonable expectations are for an extreme decreased dependency on spectacles.
Davidorf Eye Group is a frequent participant in clinical studies involving advancements in ophthalmology.
New and Emerging Technologies in Eye Care
The course, New and Emerging Technologies in Cataract and Refractive Surgery was held again at this year’s ASCRS meeting in Boston. Dr. Jonathan Davidorf is the Senior Instructor and course organizer. The course covers investigational and newly FDA-approved technologies and techniques, including presbyopic and phakic IOLs, new cataract extraction techniques including femtosecond cataract surgery and intraoperative wavefront measurements, new femtosecond lasers for refractive lenticule extraction and penetrating keratoplasty, endothelial and deep anterior lamellar keratoplasty, intracorneal lenses and multifocal excimer and intrastromal femtosecond laser treatments for presbyopia , and the i-Stent for glaucoma. "I was very pleased with the material presented, the involvement of our terrific faculty, and the insightful questions and discussion generated by the doctors who attended," said Dr. Davidorf. "A special thanks is due our faculty: Ike Ahmed, Anthony Aldave, Michael Colvard, Dan Durrie, Richard Lindstrom, Robert Maloney, Mark Packer, and Jim Salz." The Course will be presented again, with updated material, at the American Academy of Ophthalmology Annual Meeting this Fall in Chicago.
Dr. Davidorf Supports Local Charities
Recently the 6th Annual Calabasas Classic 5K & 10K Run was held to benefit the Talbert Family Foundation which assists local families with members suffering from catastrophic illnesses. Whether he participates in charities through active involvement or financial support, Dr. Jonathan Davidorf exceeded expectations as he completed a unique, back-to-back feat. After finishing in First Place in a field of 48 runners in his age group in the 5K race, Dr. Davidorf then competed in the 10K portion of the charity event.
Following his feat Dr. Davidorf commented,"This foundation does incredible work in the community and I'm thrilled to have participated. The enthusiasm and energy from all of the other runners made it so much fun that I decided to run both races."
Davidorf Eye Group is a proud sponsor of several charities and organizations both locally and internationally.
Los Angeles Vision Correction News
Also serving: Beverly Hills, Santa Monica, Pasadena, Orange County, Ventura County
The Davidorf Eye Group is a leading center for clinical research. As a principal investigator on numerous FDA clinical trials, Dr. Davidorf's research has been instrumental in advancing the field of refractive surgery.
Surgeons from around the world have traveled to Davidorf Eye Group to learn first-hand about the latest refractive surgery techniques, long before they have become mainstream.
A new report indicates that a lack of exercise may also put people at risk for the disease. Additionally, the study, which analyzed thousands of runners, found that the faster the runner the more the risk of glaucoma decreased. Read the full article.
Dr. Jonathan Davidorf recently presented Presbyopic IOL Calculations: The Aspheric ReSTOR D3 and Crystalens HD at the annual American Academy of Ophthalmology (AAO) conference in San Francisco. Read the full article.
Recently, Alcon hosted a Continuing Education presentation featuring Dr. Jonathan Davidorf and Dr. Guy Massry. Read the full article.
The May issue of the Journal of Refractive Surgery (Utine et. al.) highlights an article detailing the use of LASIK in farsighted (hyperopic) children with amblyopia (lazy eye). Read the full article.
Researchers reporting in the Journal of Refractive Surgery conclude that high patient satisfaction can be obtained with both customized (wavefront-guided) LASIK and from standard LASIK for the treatment of nearsightedness (myopia) and astigmatism. Read the full article.
To view our past articles, please visit our NEWS ARCHIVE.
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LASIK surgical technuquies and complications
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LASIK Self Evaluation Test
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LASIK - Laser Eyer Surgery Los Angeles
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See Clearly After Cataract Surgery
Cataract patients now have an option to see at both near, intermediate and far distances after cataract surgery! Individuals suffering from cataracts previously had only a mono-focal lens implant option after surgery. NEW multi-focal IOL technology can now decrease dependence on glasses after surgery. If you are seeking the Rezoom™ or ReSTOR® IOL lens options Dr. Davidorf is a certified cataract surgeon in Los Angeles that can help. Your source for Los Angeles cataract surgery!
If you are researching NEW in Eye Care or Laser Eye Surgery please feel free to read our collection of articles involving Dr. Jonathan Davidorf.
Visian ICL ™
Have you been told you are not a candfidate for LASIK. The Visian ICL can correct nearsightedness beyond the level of LASIK eye surgery. Learn why Dr. Davidorf is one of the TOP Visian ICL surgeons in Los Angeles!