All posts by Princeton Eye Group

Do you suffer from Keratoconus or Corneal Ectasia?

keratoconus

Anita Miedziak, M.D. of the Princeton Eye Group in Princeton has conducted years of clinical research trials to study the effectiveness of an innovative treatment to stop or slow the progression of Keratoconus and Corneal Ectasia. Dr. Miedziak is one, of only two, principal investigators in FDA cross-linking trials in New Jersey. She has vast experience in arresting the progression of Keratoconus and Corneal Ectasia and is now the only ophthalmologist in this area performing the procedure.

Princeton Eye Group has acquired the KXL by Avedro Inc. – the only FDA approved cross-linking system in the USA – and is the only area provider to offer this technology. For more information or to schedule an appointment with Dr. Miedziak, please call 609-924-9200.

What is Keratoconus?

Keratoconus is a non-inflammatory eye condition in which the cornea progressively thins and weakens, altering its round dome shape to a cone-like bulge which can result in significant visual impairment.

What is Corneal Ectasia?

The term Corneal Ectasia refers to a group of conditions, including Keratoconus. In some cases, Corneal Ectasia can occur after a patient has undergone refractive surgery (LASIK or PRK), where irregular astigmatism has developed. In both instances, visual impairment can increase as the cornea continues to bulge.

Symptoms

Individuals in their late teens or early twenties may experience the first signs of Keratoconus. The condition may progress for 10-20 years before stabilizing or slowing down. Each eye may be affected differently. In the early stages of Keratoconus, people might experience:

  • Glare
  • Distortion of vision
  • Ghost images

What is Cross-Linking?

Corneal collagen cross-linking is a medical procedure that combines the use of ultra-violet (UV) light and riboflavin (vitamin B2) eye drops. Corneal cross-linking:

  • Arrests progressive stretching of the corneal collagen
  • Creates new corneal collagen cross-links
  • Results in a shortening and thickening of the collagen fibrils
  • Leads to the stiffening of the cornea

corneal collagen cross-linking

 

 

 

 

For more information on Collagen Cross-Linking using Avedro KXL system, please visit our Services page.

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Voluntary Recall of PeroxiClear 3% Hydrogen Peroxide Cleaning & Disinfecting Solution

 

peroxiclear-boxBausch + Lomb is conducting a voluntary recall, proposed Class II, of PeroxiClear® 3% Hydrogen Peroxide Cleaning & Disinfecting solution in the U.S. and Canada from retailers, wholesalers, and eye care professionals. PeroxiClear is a specialty contact lens solution with a special lens case and neutralizing disc and is indicated for soft and rigid gas permeable contact lenses.

The company chose to initiate this voluntary action based on internal testing that simulated normal product use. Over the course of the recommended 5 uses of the lens case, testing showed occasional occurrences where the residual peroxide remaining in the lens case after neutralization was above product specification.

Although the product impacted by this voluntary recall represents low risk to the consumer/patient and is unlikely to cause serious health consequences, the company is voluntarily recalling the product out of an abundance of caution. If the residual hydrogen peroxide is above product specification the user of the product could experience symptoms of burning/stinging, irritation, red eye and in rare circumstances other more serious health consequences. No other Bausch + Lomb products are affected by this voluntary recall.

The decision to conduct this voluntary recall is part of our ongoing commitment to quality and customer satisfaction. We are continuing our evaluation for PeroxiClear, and it is unlikely that we will be able to return the product to the marketplace within 12 months.

Product: PeroxiClear® 3% Hydrogen Peroxide Cleaning & Disinfecting Solution
Lot Numbers: All Lots
UPC Code (USA):

310119038154
310119039106
310119038161
310119038178
310119039083
310119097120

UPC Code (Canada): 010119039211
010119039228

 

 

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Dr. Miedziak sets the mark as pioneer in corneal cross-linking for keratoconus

Exciting news that will forever change the way we approach and treat corneal weakening diseases such as keratoconus and corneal ectasia! The FDA has approved the Avedro KXL Corneal Collagen Cross-Linking System (www.avedro.com), and the Princeton Eye Group will be only one of a handful of sites in the country to launch this technology. Dr. Miedziak was one of only two investigators in NJ participating in the FDA-monitored trials, and by so doing, learned how this technology can often arrest keratoconus and corneal ectasia. There were some stunning success stories in patients who previously could not be treated. This specialized non-incisional technique utilizes riboflavin assisted UV-light emission cross-links collagen in the cornea, thereby stiffening it and often flattening extremely steep curvatures.

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Princeton Eye Group participates in world-giving

Through a sponsorship by the Princeton Eye Group, each and every employee was given the opportunity to donate necessary funds to an indigent patient in the Third World through the Watsi.org system.  Watsi is an NGO that locates patients who cannot afford necessary medical care and seeks donors to help.  Among these are a three month old infant in Guatemala suffering from malnutrition because of lactation failure of her mother. Another is a three year old girl in Kenya who has hydrocephalus and needs brain surgery. Many more examples.  Thanks to a sponsorship by the Princeton Eye Group, several dozen patients are now fully funded to receive medical care.

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Princeton Eye Group doctors are doing their part in staving off world blindness in Haiti

Cataracts are still the leading cause of reversible blindness in the world and the Princeton Eye Group is doing its share to combat this. Humanity has no borders. Dr. Sarah Kuchar has been named the Physician Coordinator of the Wills International Residency Experience which sends American doctors to St. Boniface Eye Clinic at Fond-des-Blanc, Haiti. She has tapped Dr. Michael Wong to bring a senior ophthalmology resident from Wills Eye Hospital on a mentor/service mission there. This is fully funded by the Princeton Eye Group.

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Leadership at the national level

One hundred of the most respected ophthalmologists in the world are chosen to be on the “Council of 100.” Dr. Michael Wong has been invited to join this venerated board, which advises the American Society of Cataract and Refractive Surgeons, the world’s largest anterior segment society. Dr. Wong is elated as this is an opportunity to directly shape the future direction of ophthalmology, particularly at the clinical and educational level, at a time of great change.

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Eye Trivia and Interesting Eye Facts

While putting together our new redesigned site, we asked our doctors for facts and trivia about eyes. You’ll find them scattered all around the site, but here are a few extra ones you may find interesting.

The average person blinks 12 times per minute – about 10,000 blinks in an average day.


Only 1/6th of the eyeball is exposed to the outside world.


Eyelashes have an average life span of 5 months.


About half of our brain is involved in the seeing process. Humans are very much visual animals.


The external muscles that move the eyes are the strongest muscles in the human body for the job that they have to do. They are 100 times more powerful than they need to be.


The eyeball of a human weighs approximately 28 grams, or one ounce.


Ophthalmologists are graduates of a medical school, whereas optometrists are not.


Cataract formation is a normal aging phenomenon, and so all animals in the kingdom that see will get cataracts if they live long enough.


In Lasik, the accuracy is measured in microns. A micron is one-millioneth of a meter.


On a dark night, a human eye can see a candle flickering 30 miles away.


You see with your brain. ​ The eyes sense light and is connected to the brain by over a million nerve fibers.


Theodore Roosevelt is the only president who lost an eye while still in office.


The word “eyeball” was coined by William Shakespeare in A Midsummer Night’s Dream.


The giant squid has the largest eye.


At any given point, your eyeballs are moving 70 to 100 times per second all over.


Our eyes are always the same size from birth, but our nose and ears never stop growing.


Women blink nearly twice as much as men.


Babies cry but don’t produce tears until one to three months after birth.


Of all the muscles in our body, the eye muscles are the most active.


All babies no matter what nationality or race, have blue eyes in the womb.


The shark cornea has been used in eye surgery, since its cornea is similar to a human cornea.


The most common injury caused by cosmetics is to the eye by a mascara wand.

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iStent – New Glaucoma Treatment for Cataract Surgery patients

So your doctor has told you that it’s time for cataract surgery. You are also being treated for glaucoma. There is now an exciting new technology that is available that may help either reduce your need for eye drops or improve your eye pressure on the eye drops your are currently taking. The Princeton Eye group is proud to be among the first in this area to offer this exciting new technology to its patients. It’s called the iStent Trabecular Micro-Bypass Stent. The iStent is the smallest implantable device in the human body, measuring 0.3 mm by 1.0 mm in size and it helps to allow fluid trapped inside the eye to get out more easily. The best part is, it can be done at the same time as your cataract surgery without causing any significant increase in the risk of your cataract surgery.

Glaucoma is one of the leading causes of irreversible blindness in the US today and it can come on gradually without any symptoms until the later stages of disease. It is often characterized by an increase in the pressure of the fluid inside your eye but some patients develop it even with normal eye pressure. In all cases, lowering the eye pressure can help to slow down or even stop this loss of vision from occurring. Current treatment modalities include drops, laser, or a more invasive form of glaucoma surgery known as a trabeculectomy. Trabeculectomy is a surgery for more advanced or severe cases of glaucoma where the drops are not working or the chance for severe vision loss is high. While effective in these patients, it is not appropriate for more mild cases cases of glaucoma due to its risk profile.

The iStent however, works to help allow fluid from inside the eye to drain out of the eye more efficiently, thus helping to lower the pressure. Imagine you had a drain in your shower and in order for the water to get our of the shower, it first needed to pass through a sponge. You can imagine that this would slow the outflow of water. If you took a straw however, and poked it through the sponge, the water would now have a direct path out of the shower and into the drain without having to pass through the sponge. This is exactly how the iStent works, allowing aqueous fluid (the water in the eye) to pass through the trabecular meshwork (the sponge) and out of the eye through Schlemms canal (the drain). The end result in US clinical trials were that 68% of patients at one year post-operatively were able to reduce their glaucoma medicines by one drop. With typical glaucoma copays of $50 or more per month, the savings could be hundreds of dollars per year not to mention the reduction in side effects and the worry of taking a drop everyday.

It is important to realize that not all patients will be able to reduce their drops but given it’s tremendous safety profile, it’s high efficacy rate and the fact that most medical insurances cover its insertion, it has become a highly desirable treatment for those who are about to undergo cataract surgery and who also have glaucoma.

To find out if this exciting device is appropriate for you or to schedule a consultation for cataract surgery in combination with the iStent, please call our office at 609-921-9437. Let our schedules know that you have a cataract and glaucoma and they can help you make a consultation with a surgeon in our group who does both vision saving procedures.

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intraocular lenses for cataracts

Advances in Intra-Ocular Lenses Achieve Higher Satisfaction

While the main purpose of cataract surgery is to replace a clouded lens with a clear one, thereby improving visual potential, an additional benefit is the ability to re-focus the eye in the process. A new generation of intra-ocular lenses (IOLs) imparts tremendous optical benefits without adding any medical risks to the operation. Today’s IOLs can be folded and inserted through very small incisions and are made of inert material that is never rejected and is intended to last a lifetime, as there are no moving parts.

The ReSTOR IOL can increase range of vision

The ReSTOR intra-ocular lens has become the world’s most popular multi-focal IOL, by combining both refractive optics (focusing by bending light rays) and diffractive optics (focusing by constructive interference).

The Princeton Eye Group is proud to say they were on the forefront on the research that brought this lens to market and are viewed as key opinion leaders in the industry regarding proper use of this technology. All lenses can be considered light gathering devices, and the focus point is that distance at which the majority of light rays are gathered from. The ReSTOR IOL creates two major focal ranges, about 20 feet and 16 inches. This provides excellent distance vision and adequate close focus to create a range of vision referred to as ‘casual near ability.’ This casual near ability makes all the difference in the world in day-to-day living, when you’re on the go. For the most part it gives one the ability to see your cell phone, price tags when shopping, and your food when eating and cooking. It gives you enough near vision that you don’t feel you ‘need reading glasses for every picky little thing,’ which is the complaint of many patients who are over 55 years old or have basic monofocal IOLs set for distance. The ReSTOR lens works better when inserted in both eyes, and in many instances, patients spend their lives basically free from spectacles.

Toric IOLs can neutralize astigmatism

Another tremendous advance is the toric intra-ocular lens, which is designed to correct corneal astigmatism. Astigmatism is a focusing issue whereby two focal points are created by the cornea, which is the clear flexible dome in the front of the eye. This comes about when the cornea is bent more tightly in one direction than the other, like a spoon or the side of a football. That extra bend is called toricity.

The basic concept is that this extra bend can be measured, and applied to the surface of the IOL. When the surgeon inserts the IOL, he/she merely places the extra bend of the IOL perpendicular to that of the cornea, so that the toricities cancel out each other. There is no added medical risk in inserting the lens.

The features of the ReSTOR and Toric IOLs have been combined

Considered the most scientifically advanced IOL, the ReSTOR-Toric IOL combines the features of previous technology and addresses all three components in one’s prescription: the sphere for near-sightedness or far-sightedness, the astigmatism or toricity, and the near power of presbyopia. The doctors at the Princeton Eye Group were involved in the clinical studies and presentation to the FDA to garner approval of this special IOL.

Risks

Intra-ocular lenses do not match nature. Owing to the fact that the IOL is smaller than a natural lens, the edge of all IOLs can cause glare. The diffractive aspects of a ReSTOR IOL can cause rings around light sources such as headlights from oncoming cars. These symptoms most often dissipate over time and represent a small trade-off compared to the enhanced near vision. Some patients with the ReSTOR feel they need brighter light for the reading aspects to work well. Simple over-the-counter reading glasses alleviate this mild problem.

One cannot guarantee spectacle independence for distance. Very precise measurements are taken before the surgery and that information is inputted into very precise theoretical formulae to choose the power of the IOL. However, the final to-and-fro position of the IOL cannot be predicted as this depends upon healing, and this could cause one to not obtain the refractive goal. If so, this information is used as a fudge-factor when choosing the IOL power for the second eye and ultimately, good bilateral vision results. It is important to note that you ‘see with your brain, and not with your eyes,’ and even if each eye is slightly different, good vision is achieved. But keep in mind that if the final refractive result is less than desired, the fallback position is merely mild eyeglasses or LASIK surgery on the cornea. It is important to emphasize the concept that ultimately the measure of success is restoring the health of the eye.

Butterfly with cataracts and astigmatism

Vision affected by cataracts and astigmatism

butterfly with a traditional IOL and astigmatism

Vision after cataract surgery with a traditional IOL and astigmatism

Butterfly with ReSTOR or Toric-IOL

Vision with ReSTOR or Toric-IOL

 

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Dr. Stephen Felton: “I feel very lucky.”

stephen felton bookDr. Stephen Felton began what would become Princeton Eye Group in 1980.

As he enters the twilight of his career, recently limiting his practice to three days a week, Dr. Felton has begun reflecting on an incredible life and career that nearly never occurred. For Stephen was born, two months premature, in the Warsaw Ghetto in 1942. His mother Eva Feldsztein would escape the Holocaust and Nazi tyranny with her ‘miracle’ baby, but not before experiencing and enduring unspeakable tragedy and atrocity.

Eva and Stephen survived the war with the help of the Matacz’s, a Polish Christian family, only to learn later of the extermination of Stephen’s father Victor and step-brother Stasio in the Auschwitz death camp.

This is not a subject that Eva would ever be comfortable speaking about. In fact, she never did until recording her memoirs prior to her death in 1992. Those words would later be published in I Shall Lead You Through The Nights-The Holocaust Memoir of Eva Feldsztein (ComteqPublishing.com).

Among the thousands of patients that Dr. Felton has touched in 35 years, few if any are aware of his story. He is well known in Princeton and throughout the area as an accomplished and trusted ophthalmologist and surgeon. While never comfortable talking about the past, he recently reflected, “I have always been driven to help others. I never wanted to be wealthy, just comfortable. Inside I had a fatalistic view of life knowing bad things could happen at any moment, knowing it can all disappear in a day. I wanted to be a nice person and have a good family. In that respect I feel very lucky.”

Stephen arrived in the United States in 1947, settling in Brooklyn, New York with his mother and new stepfather. His role model would become his Uncle Joe, who he would later follow into the chemical business. Stephen would earn his Ph.D in Chemistry before going to medical school at age 30. He wanted to improve people’s lives.

Today, he feels Holocaust education is critical. “People need to know how bad things can be. How can one person, like Hitler, generate that kind of hatred? How does humanity allow that to happen?”

He spoke publicly on the subject for the first time at the Princeton Jewish Center. It was a cathartic experience. “Even my close friends didn’t know my story. It was time. My mother was nothing short of an amazing, brave and kind person. I feel very lucky.”

Eva Feldzstein’s spirit and legacy lives on in Stephen, his family, his colleagues and the thousands of patients and lives that he has helped to improve.

Dr. Felton is most proud of his partners and colleagues and all that they have contributed to the community. He has performed over 10,000 cataract procedures over 35 years. And he has helped Princeton Eye Group become the most popular and respected practice in the area. “We conduct business as true partners. Through discussion and consensus we have made almost all of our important business decisions. Our collective training and caring of patients is what has bonded us together all of these years.”

Stephen and his family were reunited with the Matacz family in Poland. They were recognized in 2012 with the title Righteous Among Nations by Yad Vashem and the Israeli government for having hidden Eva and Stephen from the Nazis.

Stephen plans to travel and play more golf with his newfound ‘spare’ time.

I Shall Lead You Through The Nights is used today at colleges and universities as part of their Holocaust education programs.

Update: read more about Dr. Felton’s story in Princeton’s Town Topics.

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