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Laser Corneal Transplantation

Corneal transplantation can now be done by laser. IntraLase Enabled Keratoplasty (IEK) is a new revolutionary way of performing full thickness corneal transplantation procedure. The IntraLase laser is used to replace the diseased cornea in a precise fashion thus reducing postoperative astigmatism and corneal surface irregularity speeding up the visual rehabilitation. The IntraLase laser procedure also reduces the need for stitches which in turn makes recovery both easier and faster.

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Effective Treatments for Wet AMD

Since its introduction, Dr. Samuel M. Liu, Director of Retina Services at The Princeton Eye Group, has been providing patients with wet macular degeneration with intravitreal injections for the treatment of the abnormal blood vessels that grow underneath the retina in this condition. These medications include Macugen and Lucentis.

Lucentis is a breakthrough treatment for wet AMD that can do more than just help maintain a person’s vision. With Lucentis, people with wet AMD may actually see their vision improve. It is an FDA-approved treatment specifically developed for the treatment of wet AMD.

Wet AMD occurs when abnormal blood vessels grow in the back of the eye. As the blood vessels grow, they can leak blood and fluid, which damage the macula. The macula–which is the center of your retina–plays a key role in your central vision. Lucentis is designed to block abnormal blood vessel growth and leakage.  Along with the abnormal growth blood vessels, certain proteins are thought to play a big part in causing wet AMD. Lucentis is a treatment that targets these proteins–preventing them from causing more damage and possibly even reversing their effects.

Many people saw impressive results with Lucentis. In key clinical studies, about 95% of patients treated with Lucenti found that their vision stayed the same and up to 40% of those patients found that their vision significantly improved. However, wet AMD is a chronic condition and there is no cure. But it can become manageable by treating it monthly with Lucentis. If you have a loved one who may have wet macular degeneration, schedule a consultation to see if Lucentis may be an option.

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A Bright Future for Eye Care

By Stephen M. Felton, M.D.

Imagine never needing glasses — not reading glasses, not glasses for distance, not glasses for astigmatism. That is the challenge that ophthalmology has set for itself for the next decade. It is already happening as new techniques and instruments are being developed at a rapid pace.

This is what I saw and heard at the April meeting of the American Cataract and Refractive Society in San Diego. The great advances in eye care that I personally have witnessed over the past 30 years have been truly remarkable. I would like to share them with you.

First, let me give you some perspective on eye disorders. There are eye diseases such as glaucoma, cataracts, and macular degeneration. Then there are optics disorders such as nearsightedness, farsightedness, and loss of focusing ability, or presbyopia. The primary goal has always been curing and controlling eye diseases, but more recently a lot of progress has been made in treating optic disorders, with the goal of providing excellent vision with no need for glasses. To understand these advances, you need a simplified explanation of how the eye works.

To focus light into the retina so that you can see sharply, there are two eye structures that bend light rays to a fine focus on the retina. They are the cornea, a clear window-type layer on the surface of the eye, and the lens, a clear lens-like structure inside the eye. The cornea has a fixed focus while the lens can move and change shape to provide fine focusing.

When one or both of these structures is defective and cannot focus light onto the retina, the result is an optics disorder. Either by changing the shape of the cornea or by changing the lens of the eye, fine focus – and resulting clear vision – is achieved. The procedure, popularly called LASIK, changes the shape of the cornea to correct nearsightedness, farsightedness and astigmatism. Operating on the lens can also correct optics problems, since one can replace the natural lenses with sophisticated artificial lenses (implants) that will correct nearsightedness, farsightedness, astigmatism and presbyopia – all this to make you free of eyeglasses. When the natural lens in the eye becomes diseased and clouded (a cataract), replacing it not only restores clear vision but can eliminate the need for glasses. The surgical procedures to accomplish all of the above are sophisticated, and require skilled surgeons. For this reason, cataracts are still the main cause of blindness in the world. A great number of people in underdeveloped countries just do not have the access to skilled ophthalmology.

Two examples of the level of sophistication that have recently become available and generated a great deal of excitement in San Diego are advances in ultrasonic technology to allow more efficient and safer removal of cataracts through a tiny incision, and advances in laser technology (Intralase in the United States) to allow more precise and safer preparation of the cornea flap during LASIK.

The ultrasonic method of removing cataracts, also called Phacoemulsification, has become the modern standard. The newer technology is called “torsional Phaco” and provides an extra element of safety and efficiency.

The Intralase laser in its newest model can be used to prepare LASIK flaps with a greater accuracy and safety as compared to the conventional blade technique. Some studies have show that it provides better vision results.

The study of eye diseases is also experiencing great progress. The treatment of glaucoma and macular degeneration has improved greatly over the past 30 years. These conditions are common especially in older populations groups, but to treat them, one has to diagnose them. Both conditions can occur with few symptoms, so screening and/or regular eye examinations after the age of 40 are recommended.

An estimated 2.2 million Americans have glaucoma and another 2 million have glaucoma and do not know it. Without treatment, glaucoma can cause total blindness. Macular degeneration is also a very common eye disease. It can completely destroy central (reading) vision.

In summary, there have been major advances in the treatment of eye diseases and also in the treatment of optic disorders. If you have glaucoma, it can be stopped, and if you have macular degeneration, it can be stopped or slowed down in the majority of cases. If you are motivated to eliminate your glasses this can also be accomplished in the great majority of cases.

You must of course see your eye doctor first. During a routine examination your eye doctor will be able to tell you if you glaucoma or macular degeneration, and whether you are at risk of developing these diseases.  Your eye doctor will also be able to determine whether you are a candidate for vision correction surgery by doing a few additional tests.

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Palestinian Girl Comes to America to Receive Cornea Transplant

cornea transplant patientOn April 4, 2007 in North Brunswick, New Jersey, a 16 year old girl from the country of Palestine, Ahlam Abuowda,  received life- enhancing eye surgery.  Through the help of the Lions Eye Bank of Delaware Valley, Dr. Michael Wong, a cornea transplant surgeon, an international relief agency, and many others, the girl received a corneal transplant. Within one week, the child will significantly recover activities of daily living denied her for many years.

The recipient, at the age of 6, experienced a traumatic eye injury due to a blast from a gas canister. With inadequate medical care together with a very dry environment as well as a suspected underlying eye disorder, the girl’s vision severely handicapped her.

The eldest of 13 children, she lives in Palestine, near the Gaza Strip, in a roofless 2 bedroom apartment with 16 other people. Four of her siblings have spina bifida. Her parents and grandparents are unemployed.  Because of the region’s poverty, sufficient medical care was lacking.  The eye physicians who examined her did not have access to equipment, supplies and pharmaceuticals to provide good medical care.  However, in their assessment, they believed that her retina was fine and the damage was to her cornea.

The Lions Eye Bank of Delaware Valley recovers donated corneal tissue and distributes the corneas to physicians whose patients have no or low vision due to specific corneal diseases. Dr. Michael Wong, a Princeton, New Jersey board certified ophthalmologist who travels world wide providing free eye care to remote impoverished areas, was contacted by  the relief agency. They mailed him many different eye cases, most which were not amenable to treatment, except in the case of the young Palestinian girl.

After review, Dr. Wong decided to take the case pro bono.  He then met with the Lions Eye Bank of Delaware Valley, the region’s cornea transplant bank, explained the child’s medical plight and they too agreed to provide free services.

Arrangements were made to bring the child to America and a Palestinian host family was selected.  After she made her way to her homeland’s border crossings, she waited days to get through.  Her journey was delayed once because of nearby border bombings and yet another time because of a border killing.  Her wait was further extended due to visa problems.

And finally, when she arrived at New York’s JFK Airport, frightened by the roar of jet engines, unable to see beyond one foot, not knowing any English, what she understood and knew was the promise of a better life.

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Princeton Eye Group First Practice in Central New Jersey to Perform Revolutionary Cataract Procedure

New ReSTOR Intraocular Lens improves patients’ near and far vision

Princeton Eye Group, an eye care practice with a distinguished 25- year history, is proud to add another achievement to its long list of firsts. On June 1, Michael Y. Wong, M.D., of Princeton Eye Group became the first doctor in central New Jersey to use the ReSTOR Intraocular Lens (IOL), a revolutionary new implant for cataract patients that restores both near and far vision.

The ReSTOR IOL represents the latest breakthrough in cataract treatment. The manufacturer selected Princeton Eye Group to debut this new technology to central New Jersey patients because of its highly qualified staff and long history pioneering eye care therapies.

“This ReSTOR IOL may very well revolutionize cataract surgery,” said Steven Felton, M.D., Ph.D., and founder of Princeton Eye Group. “I’m proud to say that Princeton Eye Group will be leading the way again in this technology.”

About 20.5 million Americans age 40 and older have cataracts, according to Prevent Blindness America’s 2002 Vision Problems in the U.S. report, and as many as 30.1 million Americans will have cataracts by 2020, the report estimated.

A cataract is a clouding of the natural lens located behind the iris of the eye. Until recently, patients who underwent cataract surgery received a monofocal IOL. Although this improved distance vision, most patients still needed reading glasses to see near objects.

By comparison, ReSTOR IOL provides a full range of vision. In clinical studies, 80 % of patients who received the ReSTOR IOL reported that they never wear glasses for any activity.

“The ReSTOR lens promises to reduce older individuals’ dependency on glasses, much like LASIK did for a younger age group,” said Dr. Wong.

Princeton Eye Group, headquartered at 419 North Harrison Street in Princeton, is one of the most distinguished and respected eye practices in central New Jersey, with three fully equipped locations in Princeton, Somerset and Monroe Township. It includes Dr. Steven Felton, founder; Dr. Michael Wong; Dr. Richard Wong; Dr. David Reynolds; Dr. Anita I. Miedziak; Dr. Samuel M. Liu; and Dr. John Epstein.

Princeton Eye Group also includes Wills Laser Vision at Princeton, an ambulatory treatment center designated a “Center of Excellence for LASIK” by Wills Eye Hospital, one of the top ranked eye hospitals in the country.

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Doctor and Son Make Eye-Opening Trip to Africa

Dr. Michael Y. Wongs recent trip to Africa resulted in better vision for many people in Namibia; it also resulted in new perspective for the doctor and his 17-year-old son Matthew. Working in conditions very different from those at the Princeton Eye Group, which he cofounded, Dr. Wong restored over 100 patients from near total blindness to sight. On the journey, he also learned about the world, his son and himself.

The trip came about after Dr. Wong met someone from Surgical Eye Expeditions, a group thats the ophthalmic equivalent of Doctors without Borders, at a conference. After Dr. Wong indicated his willingness to volunteer his time and services, Surgical Eye Expeditions arranged for him to receive an invitation from Namibias Blindness Prevention Secretariat,” Dr. Ndume. Despite her grand title, she is the only ophthalmologist in charge of all the governments patients.

The Wongs met up with Dr. Ndume in Windhoek, the countrys capital and, carrying the lenses and sutures they would need, they headed out to Northern Namibia, near the border with Angola, to set up their clinic. Despite areas with US State Department safety warnings, they encountered no danger. What they did find were circumstances very different from those in Princeton.

Northern Namibia is home to a million people unserved by ophthalmology. The fact that the people there, for the most part, live in huts with thatched roofs and dirt floors posed no challenge. But, the fact that many of the people there believe in witchcraft made things difficult. They think that their cataracts,” Dr. Wong explains, are witchcraft punishments for earlier deeds, so they dont believe that modern medicine will help.”

Despite this common belief, the screeners who had been sent out before the Wongs visit had rounded up more than enough eager patients. Armed with penlights as their only diagnostic tool, these screeners found people whose eyes were clouded by cataracts that could be detected with the naked eye. Often, the patients could see some light and dark, but could not see the fingers on their hands.

We dont often see cataracts that thick in the US,” says Dr. Wong. Cataracts arent a big problem here, but they are the largest cause of preventable blindness in the world.”

At first, the team worked slowly because of communications difficulties with the nurses provided by the country. Soon, however, things accelerated to the point where 25 operations could be squeezed into an 8 a.m. to 10 p.m. day. In the end, the team did over 160 cases, with Dr. Wong doing over 100 of them himself.

The response from the Namibians was overwhelming. The Minister of Health sent his father to the camp for surgery. Patients who saw their children for the first time in years sang hymns for them and begged them to come back. Dr. Wong even got a call from the President of Namibia, Sam Nujoma.

Our short trip,” Dr. Wong says, could make a permanent difference in that area. For one, we left an autoclave and a microscope there for the next visiting doctors. More importantly, our patients will go back to their villages and spread the word that modern medicine can work.”

Despite all he accomplished, Dr. Wong is convinced he got much more out of the trip than he gave. The trip renewed his sense of why he went into medicine. When he was the age that his son is now, he had made the decision to become a doctor after reading about Tom Dooley, a medical missionary who served in Vietnam and Laos. He also gained some valuable insights.

His sense of geo-political realities was transformed by what he grasped about the lingering effects of colonialism and apartheid. Finding himself in the role of ambassador for the US, he gained new appreciation for the beauty and opportunity of his own country.

While he went to Africa out of a sense of their needs, he learned about one of his own. The lighting conditions in the eye clinic werent great, and he sometimes had difficulty seeing sutures. When I came back,” he reports, I had my brother Richard perform LASIK eye surgery on me to improve my vision.”

The most important learning, however, was about his son. Matthew, a trained Emergency Medical Technician, was invaluable on the trip. He tirelessly performed tasks beyond those usually expected of people with his training. I told him, Dr. Wong says, that the trip was the first time I saw him as a man, rather than a child.”

That, for Dr. Wong, is the ultimate value and irony of the trip. I went halfway across theworld and learned about someone who sits across the dinner table from me.”

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Princeton Doctor and His Son Gain Insight While Restoring Sight of Poor Patients in China

This summer, Richard H. Wong, MD, of the Princeton Eye Group took his son, Brian, on a trip that neither of them will ever forget. Volunteering with Surgical Eye Expeditions (S.E.E.), they traveled to Zhengzhou in Henan Province, the poorest province in China, bringing equipment, supplies and expertise that significantly raised the quality of local eye care.

I had visited Zhengzhou in 1979,” says Dr. Wong, and was eager to do something to repay them for their hospitality at that time.” The Wongs efforts transformed the lives of the people whom they treated, and the Wongs lives were transformed by the camaraderie they experienced working with the local doctors and their staffs.

When he first contemplated the trip, Dr. Wong had learned from his brother and partner at the Princeton Eye Group, Michael Wong, MD, who had taken his son to Africa on a similar trip last year, that his son could play a significant role in their expedition. To make that possible, Brian devoted much of the past year to preparing for the trip. After taking the Emergency Medical Technician course last summer and fall, he began riding with the West Windsor rescue squad. Brian also spent a few weeks at the Princeton Eye Groups surgical center learning pre-operative and post-operative care, and assisting in surgery.

At the same time, Dr. Wong began his preparations. The stated goal of the trip was for the Wongs to work with Dr. Xiaofang Zhang, the head of the Department of Ophthalmology at the First Affiliated Hospital of Zhengzhou University, to perform 100 cataract surgery cases with lens implantation. To make that possible, Dr. Wong was able to get the lens implants donated by Bausch and Lomb, a company whose products are used at the Princeton Eye Group surgery center. Then, Phil Ricco, Dr. Wongs Bausch and Lomb representative, put him in contact with Edward Hsu, a member of the Bausch and Lomb management team in China. Together, Dr Wong and Mr. Hsu were able to get a phacoemulsification machine, a piece of equipment necessary for the planned surgeries, moved from Beijing to Zhengzhou.

However, as Dr. Wong reviewed the questionnaire that had been filled out at the host site, it was clear that his hosts were interested in more than the missions primary purpose. In addition to the surgeries, they were eager for lectures on newer” technology, some demonstration surgery and transfer of skills. This changed the scope of the mission.

Luckily, because he had done so much training in preparation for the trip and because he speaks Chinese, Brian was able to help his father be efficient and productive enough to free up time for lectures. In the beginning, Brian was the only person on the medical staff who was familiar with the phacoemulsification machine, the instruments that had been brought from the Princeton Eye Group clinic and the technique of loading foldable lens implants into the injector. Soon, he was able to teach the staff surgeons how to load the injector.

The arrival of the Wongs created a stir in Henan Province. Word quickly spread that ‘an eye specialist from America was visiting Zhengzhou. Some patients traveled for days to get cataract surgery. Many of these patients had cataracts that could have been developing over 30 years and were now so hard that phacoemulsification was almost impractical. Some of these patients had never been able to see their grandchildren or great grandchildren. The joy and thanks that they expressed the next day when they could see again was deeply moving for the Wongs.

In addition to helping the patients he operated on, Dr. Wong was able to help raise general awareness among patients of the need for eye care. When his local colleagues noticed that his presence was attracting patients who would not otherwise have come to the clinic to seek help, he was made an adviser to some of the outlying clinics. The patients,” Dr. Wong notes, may have made their first visit to an eye clinic to see me, but they are likely to continue visiting. Given the skills and dedication of the doctors in Henan Province, they are in very good hands.”

Awareness was increased even more by the local media. The opening ceremony at the clinic, as well as interviews with doctors in the operating room and with patients the first day after surgery, were all broadcast on television and radio and covered in the newspapers. These media do not reach the very poorest patients in the region, but they may be reached by word-of-mouth.

Dr. Wong predicts that eye care will improve in Henan Province in the future. Although Zhengzhou is behind Beijing,” he says, they are quickly improving. In the near future, patients could be more knowledgeable. They may have more healthcare dollars to spend or they may have health insurance. The medical community there is eager to learn modern technologies, and wants to be ready to respond to an increased demand for eye care.”

In addition to their work in Zhengzhou, the Wongs visited Beijing and Qufu in Shandong Province, the birthplace of Confucius. There, during the annual celebration of Confucius birthday, which fell on Brians own birthday, they saw a show called Confucius Dream” which summed up their feelings about their journey. The show interpreted one of Confucius most famous sayings: Isnt it a delight to see to have friends coming from afar, who cherish the same ideals and follow the same path?” The message of the show was, ‘it would be wonderful (harmonious with great potential for achievement) if we could get together from all over the world and learn from each other and to help each other, the best we can. That, in effect, is what the Wongs had done, and it was, in fact, wonderful.

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Drs. Stephen M. Felton and R. David Reynolds Have Years of Experience Using Botox for Medical Purposes

Princeton, NJ – May 31, 2002 – The ophthalmologists of The Princeton Eye Group are offering cosmetic Botox treatments, now that those procedures have passed FDA scrutiny and received approval. Cosmetic Botox treatments smooth out facial creases by relaxing the muscles that cause wrinkles while allowing the ones that stretch and smooth the skin to continue performing. The treatment consists of a simple, 5-minute, in-office procedure that creates effects that last for four to six months.

While Botox is only recently approved for cosmetic purposes, it has a long history of use in medical applications. Dr. Stephen M. Felton, ophthalmologist, and Ph.D., and one of the original founders of The Princeton Eye Group, was the first in the Princeton area to use Botox for eyelid spasms, 12 years ago.

Botox,” Dr. Felton says, has been a great help for people who suffer from dystonia, the rhythmic contraction of muscles in the eye area. Now, we can take everything weve learned about the properties of Botox and how it interacts with these muscles and use it to help people maintain a more youthful appearance.”

Dr. R. David Reynolds, another Princeton Eye Group ophthalmologists and the Groups Medical Director of Services for Eyelid Plastic Surgery, has used Botox extensively as part of his practice.

The structures around the eye,” Dr. Reynolds says, are both delicate and complex. Botox is powerful, and you have to use it carefully so you get the best effect. Its amazing, but people are so finely attuned to reading faces. Botox helps to relax the facial muscles that make some people appear angry or tense.”

Botox treatments have been standard practice at the Princeton Eye Group for many years. Dr. Reynolds routinely holds clinics dedicated exclusively to Botox administration.

Botox cosmetic treatments are just the latest in a series of innovations that the Princeton Eye Group has brought to the Princeton area. In March, 2001, the Group opened Wills Laser Vision at Princeton, a LASIK vision correction center recognized for excellence in advanced eyecare by Wills Eye Hospital of Philadelphia.

The Princeton Eye Group is a full service eyecare resource located in the Princeton Healthcare Center at 419 North Harrison Street in Princeton.

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Plainsboro Police Benefit from Improved Vision

Many in Department Have Had LASIK Vision Correction at Princeton Eye Group

One by one, several members of the Plainsboro Police Department have made the decision to have LASIK vision correction done by Drs. Stephen Felton and Michael Wong at the Princeton Eye Group. When asked why so many police have opted for this procedure, Captain Tim Metheny explains, any glasses wearer who has ever made traffic stops during the summer has had the experience of having glasses fog up when you step out of an air-conditioned police car into hot, muggy weather.”

Patrolman Steven Stryker says much the same thing. Glasses can be a problem when its raining, too. You have to take them off to dry them. And any moment when you cant see is a potential problem. In addition, glasses could be a danger if you need to break up a fight. Its not likely to happen, but its something you think about.”

The decision to have LASIK,” Matheny notes, was a relatively easy decision. Detective Sergeant Richard Furda, the first one in the department to have the procedure performed at the Princeton Eye Group, had extensively researched the LASIK options. He was like a poster child for LASIK: blind as a bat without glasses the day before, and sharp-eyed the next day. Next, Lieutenant Liz Bondurant had LASIK. She, too had a great experience. If the Princeton Eye Group was right for them, I knew it would be right for me.”

Stryker was even more cautious. He waited until after Matheny and a few other members of the department had had the procedure. At this point, even the department chaplain have had LASIK vision correction.

Metheny views LASIK as a major convenience. Strictly speaking, I didnt need LASIK to perform my duties. Certainly its nice not needing to put protective goggles over glasses at the shooting range, but its not a necessity. In fact, LASIK has made a much greater difference in my personal life than in my work life.”

Metheny enjoys sports such as jet skiing and scuba diving. Previously, he had the experience of losing expensive prescription dark glasses while on a jet ski. Now, he can buy sunglasses anywhere.

While Furda and Bondurant were instantly comfortable with their new vision, it took a while before Metheny was completely comfortable with the change. I have extremely sensitive eyes,” he explains, thats why contacts didnt work for me. In addition, I had an astigmatism, so the correction Dr. Michael Wong performed was a little more complex than average.”

For both Stryker and Metheny, consulting with their ophthalmologist was essential. Talking with Dr. Wong was what sold me on LASIK. He tells you straight up whats involved, and hes done enough of them.”

I could have found,” adds Metheny, some doctor who would do LASIK for less; but these are my only eyes. They cant be replaced. I chose the Princeton Eye Group because they had already gotten great results for people in the department.”

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