Eye Care Sees New Advances

For many people, few healthcare tasks pose a greater challenge than dispensing the proper dosage of drops into their own eyes. Hold your eye open, squeeze the dropper, hope that the drops fall in the right place, pick up a tissue, wipe away the excess, and wonder whether enough of the medication landed where it was supposed to go. And, depending on the condition that’s being treated, repeat three times a day.

For years, the eye-drop nuisance has been part and parcel of cataract surgery, for two days before and up to three weeks afterward. Now, with a new technique being used by Dr. Jeffrey Boyd, owner of Eye Care of Delaware, patients no longer have to worry about dispensing the drops themselves or finding someone to do it for them.

The procedure, called, simply enough, dropless cataract surgery, is one of several surgical options available in Delaware to help people see more clearly and well into the future. Other options, though not as new, include monovision lens implants, which enable one eye to focus on distance vision and the other on close-up tasks, and a corneal surgery option called DSEAC that permits partial transplants with a shorter recovery period.

Boyd, a surgical ophthalmologist, says he has performed about 1,000 of the dropless procedures since introducing the technique in Delaware in October 2014.

The surgery, he says, “is no different from traditional cataract surgery.” The difference, he explains, is that instead of using prescription eye drops before and after the surgery, he injects a mix of medications into the eyeball after the cataracts are removed. The mixture Boyd uses includes a steroid, triamcinolone, and two antibiotics, moxifloxacin and vancomycin, which are usually prescribed as drops for patients undergoing the traditional surgery.

“Most of my patients are elderly. They often have arthritis and they’re no longer well-coordinated, so it’s very difficult for them to put drops in their own eyes,” Boyd says. “Sometimes they had to recruit their daughter to come over to put the drops in at breakfast, a neighbor at lunchtime and their son after dinner.”

Patients who undergo the dropless cataract procedure usually spend two to three hours at a surgical center, but most of that time is devoted to paperwork and preparations. The actual surgery takes 10 to 15 minutes. The mix used in the injection is milky and cloudy, so patients can expect to experience blurred vision for a couple of days after the surgery.

Most people who need cataract surgery are candidates for the dropless procedure, Boyd says. Exceptions would be individuals who are allergic to the medications, those whose eyeballs are too small to accept the injection and those with advanced glaucoma, who would be subject to greater risk of increased eye pressure.

Medicare and most health insurance policies cover the procedure, Boyd says, but the vials used in the injections are not. That’s because, though the individual drugs in the mix are approved by the Food and Drug Administration, they have not been approved for injection into the eye.

Boyd advises his patients of the drugs’ status with the FDA and is currently picking up the cost of the vials, which he gets for $25 each from the manufacturer, Imprimis Pharmaceuticals of San Diego, Calif.

Techniques in cataract surgery and refractive surgery are constantly advancing, says Dr. Andrew M. Barrett of Delaware Ophthalmology Associates, which has two offices in suburban Wilmington and another in Middletown.

Laser vision surgery can now be used to correct astigmatism, nearsightedness and farsightedness for almost anyone age 20 or older who has had stable vision for at least two years, Barrett says.

One technique that is becoming more popular is called monovision, in which a lens designed for distance vision is implanted in the patient’s stronger eye and a lens designed for reading is implanted in the weaker eye. Patients often try monovision with contact lenses, then opt for the laser surgery for a permanent vision correction, Barrett says.

“Basically, when you’re using your distance vision, the brain ignores the image it sees through the eye that is used for reading. When you’re reading, the brain ignores the image it sees through the eye that is used for distance vision,” he says.

For patients who require a transplant of the cornea, the clear front part of the eye that covers the iris and the pupil, Dr. Edward Jaoude of Delaware Eye Clinics in Milton is now using a relatively new procedure called DSAEK, which is a lot easier to say than Descemet’s Stripping Automated Endothelial Keratoplasty.

The difference, Jaoude explains, is that traditional corneal transplant surgery, known as penetrating keratoplasty replaces the full thickness of the cornea, while DSAEK replaces only the back layer of the cornea. DSAEK, while more challenging for the surgeon, requires a smaller incision in the white of the eye to remove the diseased tissue and replace it with the transplant. The result is usually an earlier return to stable vision (three months instead of six), driving and other daily activities.

While advances in surgical procedures tend to be the attention-grabbers, the landscape of routine eye care is changing, too. There’s a greater emphasis on using the comprehensive eye exam as a health evaluation tool, not just for determining whether a patient needs vision correction, says Edward DiMartino, general manager for the six Simon Eye Associates offices in New Castle County. In conducting a comprehensive exam, an optometrist could discover indicators of conditions that should be checked out by a primary care physician, DiMartino says.

Dr. Matthew Miller of Halpern Eye Care, which has 10 offices statewide, emphasizes the importance of regular eye exams for both children and adults. Because the exams are covered under the Affordable Care Act, parents should not neglect eye care for their children, he says. “Most of the time we don’t find anything, but if you screen regularly, you will pick up vision problems earlier,” he says. Miller notes that blurred vision can be an indicator not only of diabetes or pre-diabetic conditions, but also of high blood pressure or elevated cholesterol levels.

Blurred vision is sometimes caused by bleeding or swelling in the eye, which are symptoms of diabetic retinopathy, the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults, according to the National Eye Institute, a division of the National Institutes of Health. High cholesterol can cause retinal vein occlusion, a blood clot that causes sudden, painless vision loss.

Miller recalls examining his father and finding blood in his eye. It turned out that his father was suffering from high blood pressure and needed treatment by his primary care physician. “Regular eye exams can be very helpful,” Miller says. “Sometimes you find things that patients wouldn’t ordinarily think of.”