The doctors and staff at The Princeton Eye Group are excited to announce our new and improved website! Check it out at http://www.princetoneyegroup.com/
Posted from Princeton Eye Group link
April 13, 2015 at 09:17AM
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.
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.
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 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.
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.
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.
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.
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.
Dr. Epstein has been teaching ophthalmology residents at Wills Eye Hospital for the past 10 years. Spending time in the Wills Cataract and Primary Eye Care Clinic and the operating room teaching cataract surgery is his way of giving back to his alma mater. Dr. Epstein derives great pride in knowing that his efforts ensure the next generation of cataract surgeons are as talented as the current one.
“It is such an honor and a privilege to teach at one of the top eye hospitals in the world” says Dr. Epstein of Wills. “The residents are so bright and eager and are sponges for knowledge. They constantly ask questions and listen intently. It forces me to be at the top of my game. Seeing their progression from pupils to star cataract surgeons is extremely rewarding.”
It is not always easy though. “Performing cataract surgery and teaching are two different skills but one reinforces the other,” according to Dr. Epstein. “I love the challenge of explaining how to do something that comes naturally – breaking it down into its component parts and simplifying it so it can be repeated.” Advanced technology used in cataract surgery is constantly changing and a surgeon needs to be able to adapt to these new technologies in order to offer the best care for their patients. “My job is not just to teach the residents how to use the currently available methods but to build a foundation of skills in order to continuously improve and utilize new technology as it becomes available.”
Asked why he would give up the equivalent of two weeks vacation a year to teach at Wills, the answer is readily available. “Ultimately, doctors go into medicine to help people. In a surgeon’s career, he or she will have the opportunity to restore vision and improve the lives of tens of thousands of patients. By educating the residents, I can amplify that impact to hundreds of thousands of patients. It’s a way I can maximize my positive impact on society.”
Teaching has another unexpected benefit. According to Dr. Epstein, “Teaching fundamental and advanced techniques makes you a better surgeon by forcing you to constantly re-evaluate your own mechanics and skills.” All of the doctors at Princeton Eye Group help to teach residents, medical and college students from Wills Eye Hospital, Robert Wood Johnson Medical School, and Princeton University.
Dr. Michael Wong, a pioneer in minimally invasive cataract surgery, is the distinguished recipient of the New Jersey Inventors Hall of Fame’s Innovator’s Award. This recognition honors lifetime achievement, invention and innovation among outstanding, New Jersey-based scientists, engineers and researchers.
Dr. Wong is the first clinical physician to be honored as an innovator by the New Jersey Inventors Hall of Fame. His surgical procedures to correct cataracts, the most common and treatable form of blindness, reduce the rate of post-operative infection and promote faster healing. The technique he developed, known as the ‘Wong Way,’ is now used world-wide. For three decades Dr. Wong has been in the vanguard in refractive surgery in central New Jersey, introducing radial keratotomy in the 80’s and LASIK surgery in the 90’s. He has also been recognized with the Distinguished Physicians Humanitarian Award by the University Medical Center of Princeton at Plainsboro for charitable work performed locally, as well as overseas in Africa and South America.
The New Jersey Inventors Hall of Fame was established in 1987 to honor individuals and corporations who have made New Jersey ‘The Invention State.’ Previous Innovator Award recipients include Lyman Spitzer, Jr. for distinguished achievements in stellar dynamics, plasma physics, thermonuclear fusion and space astronomy; Frank B. Gilbreth, who pioneered the field of scientific workforce management, positively affecting engineering, education and personnel
procedures; and John von Neumann, who established the mathematical architecture of computer logic and concept of internally stored programs.
Upon being informed of the award, Dr. Wong said, “I am honored to keep company with these distinguished past recipients and the other awardees.”
After winning the award, Dr. Wong was elected to serve as the Selection Committee Chairman for the New Jersey Inventors Hall of Fame, a position he currently holds. He admits, “It’s fun having the opportunity to read all sorts of science and review patents.”
According to an article in The Archives of Ophthalmology, researchers have estimated that 20.5 million Americans over the age of 40 have a cataract in at least one eye, and women are nearly 40 percent more likely to develop them than men.
In the elderly, cataracts are the most common cause of vision loss. Cataracts are the clouding over of the clear, crystalline lens inside the eye. This cloudiness scatters light, reducing contrast and causing glare, especially in bright light or while driving at night.
The common treatment for cataracts involves removing the cloudy lens with ultrasound that liquifies the cataract, and then restoring vision with an intraocular lens transplant.
Dr. Michael Wong has developed a technique to improve the sealing effect for sutureless clear corneal cataract incisions. He creates a supraincisional stromal pocket just before making the clear corneal incision. This pocket is hydrated at the end of the procedure to increase a downward pressure to oppose the upward force of the intraocular pressure. This compresses the clear corneal incision, improving its seal to speed healing and reduces the chance of infection. This ‘no-stitch, minimally invasive technique’ is used world-wide, and has been featured in the most prominent medical journals.
Dr. Wong has contributed his method to a major ophthalmology textbook titled Mastering Refractive IOLs: The Art and Science, edited by David Chang.
Congratulations Dr. Wong!
Samuel M. Liu, MD, PhD is the Director of Retina Services at Princeton Eye Group. He sees consultations for all types of retinal diseases, and has provided us with a summary of the latest updates on the treatment of macular degeneration.
There are two main types of age-related macular degeneration (AMD). The ‘dry’ form of AMD results in the degeneration of nerve cells in the center of the retina (the macula). There is no cure for this atrophy, but generally speaking, the process is usually slowly progressive. At this time, the only option for possibly slowing down this type of degeneration is the use of anti-oxidant vitamins.
In 2006, the first Age-Related Eye Disease Study (AREDS) led by the National Institutes of Health found that patients taking the original AREDS supplement formulation — 500 mg of vitamin C, 400 IU of vitamin E, 80 mg of zinc, 15 mg of beta-carotene, and 2 mg of copper — were 25% less likely to progress to advanced AMD than patients who received a placebo. There was additional evidence outside of the trial that suggested that diets high in lutein, zeaxanthin, and omega-3 fatty acids might reduce progression of AMD. For this reason, a second large multi-center trial was commenced, named AREDS2. Other research suggested that beta-carotene, which was part of the original AREDS formula, might increase the risk of lung cancer in smokers, so it needed to be studied more carefully. The dosage of zinc also was examined in AREDS2. There was concern that the 80-mg dose of zinc in the original study might place some patients at risks of side effects.
In 2013, the AREDS2 Study Group released their first conclusions. Although the study design was complex, essentially AREDS2 discovered that those who took an AREDS formula with lutein and zeaxanthin but no beta-carotene, reduced their risk of AMD progression by about 20%, compared with participants who took an AREDS formulation with beta-carotene but no lutein or zeaxanthin. This particular sub-group’s results were especially notable, because the removal of beta-carotene from the recommended AREDS formula would also reduce the potential for increased lung cancer risk in previous or current smokers with AMD. Since the release of the AREDS2 data, Dr. Liu’s recommendations for AREDS vitamin supplements are as follows:
For patients who have never smoked and are taking an original AREDS vitamin supplement, Dr. Liu recommends continuing to take the original formula, based on their lower risk of lung cancer as nonsmokers, and the longer clinical track record of the original AREDS formula. In most cases, the cost of the original formula vitamins is also less than the newer formula.
Smart Glasses: Wearable Technology Devices
Computer technology is constantly evolving. Computers are smaller and more powerful than ever. They come in all shapes and sizes are now an integral part of everyday living. It was only a matter of time before you would see some of this technology integrated into your eyewear.
Smart glasses are a wearable technology device that bring data and Internet access from a wearer’s computer or smart phone into their field of view through a transparent heads-up display. One of the first companies to come out with a wearable technology device is Google and their Google Glass.
Yet with all the functionality and usability displayed through the heads-up display (HUD), the need for prescription lenses is critical. Without corrective lenses for these devices, many users cannot fully experience smart glass technology. For those who do need corrective lenses for their Google Glass, The Optical Shoppe is happy to offer Smart Frames and Smart Gold prescription Lenses.
The Smart Frame is a full frame insert that attaches to your Glass. It is available in 8 styles and in a variety of colors.
Smart Gold lenses are designed with an optimized viewing area to provide visual acuity and clarity when looking at the HUD. It is a digitally surfaced lens so the quality and accuracy of the Prescription is uniquely customized to each patient. Due to the innovative design of the Smart Frame, we are able to insert almost any prescription with any style of lens, whether it be a single vision lens, bifocal or progressive lens. We can also prepare prescription sunglasses.
OrCam for the Visually Impaired
Also in the genre of Smart Eyewear is the OrCam. For those who are visually impaired, the OrCam is a smart camera mounted on the frames of the user’s eyeglasses, that processes visual input in real time. It identifies printed text and reads it to you instantly. The OrCam can even recognize money notes. Its small, portable design allows patients to read text on a variety of surfaces and recognize pre-entered objects independently, at home and on the go.
With the OrCam, you can read newspapers and books without asking for assistance or searching audio books. It also reads texts on computer and smartphone screens with no need to learn new software and tools.The OrCam benefits patients with a variety of eye diagnoses, including macular degeneration.
Speak to Sam Morgenstern, N.J. Licensed Optician TD-1782, at The Optical Shoppe to learn more about these latest technologies in eyewear by calling any one of our three locations: Princeton 609-683-7994, Somerset 732-565-1440 or Monroe Twp. 609-655-7776.
Notice anything different when you came for you last visit? The doctors at the Princeton Eye Group have made a few changes. The most visible change has been a major renovation to our reception area, front desk, and patient exam rooms in our Princeton location. In order to improve upon comfort and convenience for our patients, we have undergone some major construction to expand the size and improve the ambiance of our reception area. We’ve also created several new exam lanes to allow patients to be seen in a timely fashion. Additionally, we added complementary internet access to allow patients to continue to use their computers and other smart devices while visiting at our office.
You might also notice that we now have computers in each exam room. We have recently updated and improved our phones, computers and networking equipment in order to integrate electronic medical records into our practice. This exciting technology has many advantages to improve speed and accuracy. For example, the doctors are now able to view your medications directly from your pharmacy, and even prescribe a refill or new medication electronically with just the click of a button. We’ve also implemented a new call center to improve hold times and provide quality service when patients call us over the phone.
Even more exciting, the doctors at Princeton Eye Group are proud to offer patients the most state of the art technology to provide a speedy diagnosis and treatment of various eye conditions. Is there a concern for glaucoma? The most advanced care is available here. Our recently upgraded optical coherence tomography (OCT) can be used to take an objective look at your optic nerve, determine if there is damage consistent with glaucoma, and track changes over time. Combined with our visual field machine and pachymeter (measures the corneal thickness), a customized approach to diagnose and treat glaucoma is now possible in even the earliest stages of disease. We also have two glaucoma lasers right at our fingertips– selective laser trabeculoplasty (SLT) and laser peripheral iridotomy (LPI), so certain types of glaucoma can be managed by simply walking down the hall! On the glaucoma surgical front, the Princeton Eye Group is proud to be one of the first in the area to offer the iStent, a tiny implantable device that can be placed into the drain of the eye during cataract surgery to help lower eye pressure.
But what if you have a problem with your retina? Great news, our retinal OCT is a noninvasive way to image the retina with an accuracy of 10 microns (that’s 1/10000 of a centimeter!) to diagnose various medical conditions that are not always visible at the slit lamp. Patients with macular degeneration, macular edema, macular pucker are just a few of examples of patients who are already benefiting from this technology. We also offer fluorescein angiography right in our office to better determine which patients might benefit from a retinal laser or an intravitreal injection on the spot.
Princeton Eye Group also has two minor surgical suites onsite, including one upstairs for those having LASIK and other types of refractive eye surgery. Our LASIK area also features our Pentacam, which images the front part of the eye in a multidimensional way. With this machine, we can determine whether refractive eye surgery is safe for you, if you have irregularities of the cornea (such as keratoconus), how to align a toric (astigmatism correcting) lens implant, and much more. Our second surgical suite allows us to perform various eyelid procedures, intense pulsed light (IPL) treatments for dry eye and blepharitis, glaucoma lasers, and Nd:Yag laser to clear any haziness that may occur after cataract surgery in a matter of minutes.
While in the past, patients may have needed to travel to an academic institution in New York City or Philadelphia for the latest state of the art care, the multi-specialty doctors at the Princeton Eye Group are now able to manage most patient conditions without all the inconvenient travel. We strive to remain on the cutting-edge of the latest advances in technology and research so that you know when it comes to your eyes, you are getting the best of the best. Here’s looking to the future!