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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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Teaching at Wills is Its Own Reward For Dr. Epstein

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.

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The ‘Wong Way’ Leads to Innovators Award for Dr. Michael Wong

parts of the eyeDr. 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!

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Macular Degeneration: AREDS2 Vitamin Update

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.

A diet rich in spinach and fish helps promote healthy eyes.

A diet rich in spinach and fish helps promote healthy eyes.

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:

  • No evidence of AMD on examination: Dr. Liu recommends a diet rich in green, leafy vegetables and omega-3 fatty acids, supplemented with a daily multivitamin.
  • Evidence of early or moderate AMD on exam: Dr. Liu recommends the same healthy diet and multivitamin, supplemented with an AREDS2 formula vitamin containing lutein and zeaxanthin.
  • Evidence of advanced AMD on exam: Dr. Liu does not recommend adding an AREDS vitamin, because this has not been shown to prevent progression in either of the AREDS studies.

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.

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