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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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New at The Optical Shoppe: The Latest Technology in Smart Eyewear

Smart Glasses: Wearable Technology Devices

smart gold lenses for Google GlassComputer 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

orcam for the visually impairedAlso 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.

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Princeton Eye Group Invests in Major Improvements for Patients

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!

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Third World Cataract Mission Trips

Dr. Michael Wong has been fortunate to have a strong support system both in his associates at the Princeton Eye Group and his family, that allow him time to help those in need.

“I simply see the work I do overseas as an extension of what I do here locally. There are no borders to humanity,” explains Dr. Wong. His many international contacts through organizations such as Surgical Eye Expeditions and Vision Outreach International helps tremendously in the logistical planning. He plans on making annual missions in the future in addition to the significant amount of charity provided locally by the doctors of the Princeton Eye Group.

You coordinated an “eye camp in Oshakati, Namibia. Tell us about it.

Surgical Eye Expeditions connects a host ophthalmologist from a needy country with a willing volunteer such as me. Namibia is fortunate to have a dedicated “Blindness Secretariat” by the name of Helena Ndume. After a brief correspondence, I gathered my son Matthew, age 16 at the time, and hauled surgical supplies along with a caravan of Red Cross volunteers and nurses, to this impoverished area of Namibia near the Angolan border. This area had been ravaged by a civil war and drought. Those in need of eye surgery basically wait, years at a time, until an “eye camp” can be set-up, and only hope that they make it on the list. There was more work than expected, but undaunted, we worked 16 hour days and actually took care of every last person who had come, some from hundreds of miles away, many by foot. The medical situation was challenging, but the people couldn’t have been nicer or more appreciative.

Twice you’ve gone to remote villages in the Andes mountains of Peru under difficult circumstances. You performed 75 cataract surgeries and 25 surgeries for individuals with crossed eyes in Juliaca and repeated that program in Huamachuco. Describe those trips.

It was a compelling story, one to which I had to respond. The indigenous Indians of Juliaca, descendants of the Incans, are amongst the most impoverished in South America, caught between neglect and civil war. At nearly 14,000 feet elevation, the extreme UV light has caused an epidemic of cataracts. Without supplies, the local ophthalmologist was hamstrung. This adventure included my son Scott, and the two of us completed the first cataract surgeries done in that region in decades. Unprepared for the elevation and freezing temperatures, this was the most difficult trip for me from a physical point-of-view. I suffered the worst headaches of my life and developed asthma. Still worth my going, nevertheless.

The Huamachuco trip presented other challenges. Arriving at this site, the entire country of Peru underwent a general strike. The town services shut down, including the nurses at the hospital. So I “deputized” the handful of teenagers who volunteered for the trip, taught them operative technique and transformed them into operating nurses. My daughter Julia, 16 at the time, who came along thinking she would be doing some paperwork and taking pictures, was “first scrub-assistant” for the very first modern-day cataract operation in Huamachuco. I learned how much youthful exuberance and enthusiasm can do when push comes to shove.

You’ve included your family in some of your service trips. Tell us about that.

It’s more fun when you can share and learn, and never better than with your family. All three of my children have been on overseas missions with me, and they did so eagerly and have not been disappointed. My wife, an R.N., switched gears and went from being a cardiac nurse to an ophthalmic nurse so that she can come on these missions with me. It has become a family affair and an enriching one at that. I learn from these trips: about humanity, about other peoples, about myself. What the kids learn is different, as they come from a different perspective, but learning they do. Not sure what, but the experience is so different from the book learning in Princeton. I encourage young people to explore in these directions. Many say it’s life-transforming.

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Dr. Epstein’s Passion for Music Helps Raise $40,000 for the Deaf

Dr. John Epstein, a long time guitarist with a passion for music, wanted to make sure his kids shared this important part of his life. His daughters began playing musical instruments at the age of 5, and now his 11 year old daughter, Isabella, plays piano, harp, cello, keyboards, accordion and flute. His 9 year old daughter, Madeline, plays electric and upright bass, piano, and drums. His wife also plays flute and can sing. So what do you do with all that talent under one roof? Why, of course, you start a band. Thus, ‘PJ Rocker’ was born. Their first major gig was to play at Dr. Epstein’s own 40th birthday party.

In another particularly special moment, Dr. Epstein was invited to be a guest guitarist at a charity concert at the famous Canal Room in New York City to benefit the Clark School For the Deaf. His daughter Madeline joined him on bass. They played in front of over 300 people and helped raise $40,000 for the charity. Truly a night both father and daughter will never forget!

School has caused the Epstein girls to take a rest from ‘touring’ this past winter, but look for ‘PJ Rocker’ in the open-mic scene throughout the area this summer.

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Results are in: doctors who’ve had LASIK give high satisfaction rate

Surgery to correct refractive errors has undergone a tremendous evolution since inception 20 years ago. Every five years or so, the technology has leaped forward, so that each generation is ‘heads and shoulders’ above the generation before. Wills Laser Vision at Princeton is widely credited for having pioneered the latest innovations and has always been first to upgrade technology every step of the way. At this point, LASIK is now established as a mainstream procedure. Several recent surveys startlingly highlight how much so.

In a recent survey of physicians, the Journal of Cataract and Refractive Surgery, reports how beneficial LASIK can be. Over 40% of refractive ophthalmologists have had this procedure performed on themselves and nearly 90% have had a relative have it as well. The satisfaction rate was overwhelming. 96% said they would have it again. The vast majority said that they see better after LASIK than they did with glasses or contacts. None said that they saw worse. None were unhappy.

Another nationwide study conducted by Dr. Francis Price of Indiana compared LASIK patients against contact lens and eyeglasses wearers. All three groups were generally happy, but when LASIK patients were asked to compare themselves against themselves wearing contacts or glasses, they overwhelmingly touted the benefits of LASIK. The majority said they see better after surgery, with less nighttime glare than they had with contacts or glasses. The vast majority said the comfort of their eyes and convenience made a big difference. In the right person, it is clear now that the safety of LASIK supersedes the safety of contact lens use.

This presumes that the highest level of care is taken when having LASIK. This starts with the better diagnostics beforehand that can rule out improper corneas. The Pentacam analysis, available at Wills Laser Vision at Princeton, is considered the world standard for pre-op analysis. For surgery, while the expertise of the surgeon is obviously most relevant, every surgeon must have the best tools. At Wills Laser Vision at Princeton, the recognized ‘best in its class’ lasers are employed. There are two lasers involved, and Wills Laser Vision at Princeton is the only center in Central NJ that has either. The laser that does the sculpting of the cornea is the Allegretto Eye-Q 400. The ‘400’ refers to the fact that the tracking system re-aligns the laser to the center of the tracked pupil of the patient 400 times a second. This assures perfect alignment of the laser to the visual axis of the eye, even if the patient is a bit nervous and moves a little. The ‘400’ also refers to the fact that the sculpting is done with many, many, fine, delicate pulses, as opposed to the coarser ablations at 10 times a second done with competing lasers. No one else in Central NJ has this system. To prepare the eye for sculpting, another laser is used to lift up the skin overlying the cornea. The most advanced tool in the world for this is the Alcon FS200. It measures tissue particles in microns, delivering precise laser pulses finer than the diameter of a human hair. Wills Laser Vision at Princeton was the first in the Mid-Atlantic States to utilize this technology.

A recent article by Nicole Kwan on reports ‘LASIK eye surgery safe in long-term’. The article cites a retrospective study of LASIK patients by Spanish researchers that determined 10 years after LASIK, patients had healthy corneas and their vision remained accurate. The article also points out there are fewer long-term studies now because of the proven safety and effectiveness of the procedure.

Wills Laser Vision at Princeton has become the flagship LASIK center for the Wills Eye Surgical Hospital and Network. Wills Eye Hospital is commonly acknowledged to be the premier eye institute in the United States. It is not surprising that the best technology is found there. Almost all of the physicians at Princeton Eye Group were trained at Wills Eye Hospital and most are still actively involved in education of residents and other ophthalmologists.

In fact, some of the doctors of the Princeton Eye Group have undergone LASIK on the very same equipment as their patients. Dr. Epstein, Drs. Richard and Michael Wong, and Dr. Jadico, as well as the wives of Dr. Felton, and Drs. Richard and Michael Wong have also had LASIK performed by their beloved doctors of the Princeton Eye Group.

Most patients who’ve been part of the LASIK revolution will say that this procedure was life transforming. ‘A Miracle’, many have written in their post-operative reviews.

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Keratoconus and Cornea Ectasia Participants Welcome. You May Benefit from this Study

Do you suffer from Keratoconus or Corneal Ectasia?

Dr. Anita Miedziak, M.D., is conducting a clinical research trial to study and investigational treatment to stop or slow the progression of keratoconus and corneal ectasia.

You may qualify to participate if you:

  • are 12 years of age or older
  • were diagnosed with keratoconus or were diagnosed with corneal ectasia after you received refractive surgery (e.g., LASIK, PRK)
  • are able to come in for at least 8 office visits over a 12 month period

Please call the Princeton Eye Group at 609-924-9200 and ask to speak with Janet Bergan for more information and to schedule an appointment.

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