NEWSLETTER - WINTER 2001
/ SPRING 2002
|Drs. Fine, Hoffman,
and Packer with office staff.
With so many ophthalmologists easily available within a small geographic
area we are frequently asked Why should anyone choose a particular
ophthalmologist or practice for their cataract surgery? In responding
to this question we thought we should make a statement about what
differentiates us from all other practices - not only within our own
geographic area, but nationally and internationally as well. Ultimately,
we feel that our renown stems from the fact that our practice strives
to provide unsurpassed patient care in combination with the most technologically
advanced approach to cataract surgery that there is to offer.
Successful cataract surgery is the product of these main ideals along
with many other elements that continue to set this practice apart
from all others. While it is common knowledge that Drs. Fine, Hoffman,
and Packer offer the most advanced small incision cataract techniques,
you may not be aware that many of these techniques were developed
by us at the Oregon Eye Surgery Center and are rapidly becoming the
cataract techniques of choice throughout the world.
Besides meticulous surgical technique, one of the most important
elements for a successful surgical outcome is the preoperative measurement
of eye length which is used to calculate the lens implant for your
eye. We have both the Zeiss IOL Master and Quantel Immersion biometry
available to insure the most precise preoperative measurements for
intraocular lens calculations. Most practices use only one device
for these measurements, not two, and none in our area are utilizing
these more advanced machines.
Our results are constantly evaluated and refined using sophisticated
software programs. These programs update our lens power calculations
by analyzing postoperative outcomes and making fine alterations in
our formulas to maximize accuracy. It is because of these continued
refinements and precise measurements that we are able to offer some
of the most accurate lens power determinations in the world.
Most ophthalmologists utilize intraocular lens implants of the same
design, material, and manufacturer for all of their patients. We customize
the lens implant for each patient, altering not only the power but
also the design and biocompatible material based on each patients
unique ophthalmic anatomy, pathology, and postoperative visual requirements.
We utilize small incision foldable lenses that not only eliminate
nearsightedness and farsightedness, but can also reduce astigmatism
and treat presbyopia to reduce your dependence on glasses for near
as well as distance vision.
We are one of a select group of practices that are continually involved
in the research and clinical investigation of the latest intraocular
lens designs and cataract removal technologies. Due to our relationship
with the ophthalmic industry, we are able to offer some of the most
advanced and safest cataract surgery technology and the most advantageous
intraocular lens designs to our patients many years before they become
available to the general public. These include new multifocal and
accommodative lenses that provide both near and distance correction
as well as the newest intraocular refractive lenses for our elective
We make an extra effort to perfect the postoperative refractive error
so that a larger percentage of our patients have the best possible
distance vision without glasses. This is accomplished not only by
eliminating nearsightedness and farsightedness but also by reducing
astigmatism with the placement of corneal astigmatic incisions (when
appropriate) at the time of cataract surgery. This additional technique
is guided by sophisticated computerized maps of the surface contour
of the eye to insure the best possible result. Many practices do not
treat astigmatism at the time of cataract removal, but we try to utilize
every means possible to improve the surgical outcome.
Perhaps the most important element of our practice that sets us apart
from others is our staff. Our highly skilled technicians are constantly
upgrading their expertise through continued education at national
meetings. They are continually studying for higher levels of certification
and many have achieved the highest level of training for ophthalmic
technicians in the country.
We are most fortunate to be able to operate at the Oregon Eye Surgery
Center, a world-renowned facility dedicated to state-of-the-art eye
surgery. It is staffed with a superb team of highly trained nurses
and technicians. Unbelievable as it may seem, the Oregon Eye Surgery
Center has more cataract removal technology than any hospital or teaching
institution in the entire world. Ophthalmologists from all over the
world attest to this when they come here to learn the latest techniques
and observe the newest technology in action. [ top ]
Despite advances in research and therapeutics,
glaucoma remains a major cause of preventable blindness in the United
States and the world. Known as the sneak thief of sight, the most
common form of glaucoma causes no symptoms and causes irreversible
damage to the optic nerve. Nevertheless, we are making progress in
the battle to preserve vision.
|Mark Packer, M.D
The diagnosis of glaucoma is based on characteristic damage to
the optic nerve and peripheral vision. Generally, damage to the
nerve is evaluated by the ophthalmologist during a dilated examination
of the eye. The hallmark of the disease is progressive cupping or
hollowing out of the nerve. Now, a new imaging system, the Heidelberg
Retinal Tomograph, is available at Special Procedures within our
Oregon Eye Institute. In just a few seconds this device captures
a minutely detailed image of the optic nerve, which is stored in
a computer and available for later comparison. This new objective
measurement of the optic nerve will enable us to recognize progressive
damage at an earlier stage and institute sight-saving treatment.
Reducing the pressure inside the eye (intraocular pressure, IOP)
remains the only proven therapy to preserve vision in glaucoma.
The recent publication of the Advanced Glaucoma Intervention Study
(AGIS) demonstrates that lower pressures mean improved outcomes.
While ophthalmologists once believed that a pressure between 10
and 22 millimeters of mercury (mm Hg) was normal, we now understand
that some people run a higher pressure but never develop disease,
while others run a normal pressure yet suffer ongoing damage. The
AGIS has shown that reduction of eye pressure to a level below 15
mm Hg means preserving vision for those with advanced glaucoma.
Our primary means of reducing pressure involves the daily use of
topical medication in the form of eye drops. Fortunately, new classes
of drugs have become available that do a better job reducing pressure,
have fewer side effects and require less frequent administration.
A group of drugs related to fatty acids have proven very useful
in lowering pressure with just one drop each day. This group of
drugs includes Xalatan, Lumigan and Travatan. We also continue to
employ a variety of other medications as indicated and tolerated
to control pressure.
When medication is not adequate to control the pressure we turn
to surgical modalities. The most commonly performed operation for
glaucoma, the trabeculectomy, involves the creation of a new drainage
channel in the wall of the eye that allows the aqueous humor to
flow out more freely, lowering the pressure. However, immediately
following surgery the pressure may become too low and cause unwanted
side effects. Scarring of the drainage channel may also cause the
operation to eventually fail.
A newer approach to glaucoma surgery involves techniques that do
not penetrate the wall of the eye, but rather create a very thin
window through which the aqueous fluid drains. This non-penetrating
surgery has a better safety profile than the standard trabeculectomy,
but may not always lower the pressure to the same degree. The Aqua
Flow, a collagen implant, is employed with this procedure to prevent
The latest development in non-penetrating surgery involves the
use of a laser to construct the drainage window. We have sought
a better method because construction of such a thin layer of tissue
with a diamond or sapphire knife sometimes fails. One laser well
suited to this technique is the erbium: yttrium-aluminum-garnet
laser, or Er: YAG.
This laser offers an improved technique for non-penetrating surgery
because of an elegant physical principle. The wavelength of light
emitted by the laser is highly absorbed by water. As the laser sculpts
the tissue, aqueous fluid begins to drain from the eye and absorb
the laser energy. As the flow of fluid increases, more laser light
is absorbed by the water and less is absorbed by the tissue, until
finally all of the energy coming from the laser is absorbed by water.
At this point no further tissue is removed, and the perfect thin
window has been created.
Laser assisted non-penetrating glaucoma surgery represents an exciting
new modality in our fight to preserve vision. The laser manufacturer
may soon conduct FDA-monitored clinical trials to prove its efficacy.
Our practice has often served the FDA as a site for the study of
promising new technology. We look forward to providing the advantages
of new technology to our patients, years before they are available
elsewhere. Please watch our newsletter or check our web site for
further developments regarding laser-assisted, non-penetrating glaucoma
surgery. [ top ]
| Richard S. Hoffman,
A recently had the honor of participating in the 25th Moacyr Alvaro
International Ophthalmology Symposium in São Paulo, Brazil.
I was asked to give three talks including a prestigious presentation
at the opening session. I found the Brazilian ophthalmologists to
be extremely friendly and appreciative of foreign physicians traveling
to their country to demonstrate the newest techniques and technologies.
I was chaperoned throughout my stay by one or more of the ophthalmology
fellows training at the Federal University. They were unbelievably
helpful ensuring my trip was comfortable and safe. On the first
day, I presented our practices work on the Implantable Miniaturized
Telescope (IMT). The opening session was followed by a cocktail
hour and dinner. Dinner in Brazil is much later than in the U.S.
and didnt start until midnight. (The Americans in the group
were quite hungry by then!)
|São Paulos infamous Brazilian barbecues
My presentations the following day included an interactive video
session titled Difficult and Challenging Cases in Cataract
Surgery. It was wonderful to be able to offer so much useful
information to the Brazilians. They were eager to learn and it was
enlightening to see that many of their ophthalmologists were practicing
at a technical level that was close to that of U.S. surgeons.
Later we had an authentic Brazilian dinner followed by awonderful
Samba show. It was a spectacular concert with a twelve-piece band
featuring a renowned Brazilian singer. I was also able to visit
one of São Paulos infamous Brazilian barbecues. These
are elegant restaurants whose waiters continuously bring grilled
Brazilian beef to your table, carving off slices of all of the tastiest
cuts way beyond the point where common sense tells the patron to
São Paulo is an exotic bustling city of 22 million ethnically
diverse, beautiful and kind people moving to the invisible rhythms
of Samba drums in the tropical afternoon summer rains. In all, it
was a wonderful adventure and I look forward to returning to Brazil.
My stay there was much too short. [ top ]
What is a refraction?
The refraction is the portion of your eye exam that measures your ability to see an object at a specific distance. Our technicians perform refractometry. From the exam chair you look through the phoropter toward an eye chart. The phoropter contains lenses of different strengths and types that can be moved into view. Our technicians will ask you which view is clearer as they place different lenses in front of the eye (“Better one or better two?”). When you are able to read the chart most clearly, the technician makes note of the lenses used. This process takes time and patience due to the interaction required for the most accurate outcome.
Why is the test performed?
A refraction is not just for an eyeglass prescription, although a new prescription is often the byproduct of a refraction. The refraction is a critical part of any eye examination. It helps the doctor determine whether your vision is reduced by a medical eye disease (such as cataract, macular degeneration, etc), and helps the doctor follow the progression of cataracts and other conditions.
When you experience, or we measure a change in vision, a refraction is necessary to determine the extent of visual change and possible reason. When the refraction is complete, the doctor compares the new information obtained to your vision with your current glasses. This helps determine whether or not vision changes are due to a need for a new glasses prescription or to a possible medical problem that needs further exploration.
Will your insurance pay for it?
Refraction has always been a non-covered service under the Medicare program. Medicare does not differentiate between “medical refractions” (as described above) and refractions performed solely for the purpose of providing glasses. As a result of Medicare not covering refractions, your secondary insurance to Medicare may also deny the charge. Our practice will submit this charge to Medicare on your behalf so that it can then be forwarded on to your secondary insurance carrier.
Other insurance plans vary depending on your individual benefit coverage. In our experience, unless you have vision benefit coverage your insurance will probably not cover the cost of refraction. Our practice will submit this charge to your insurance carrier on your behalf whether they cover the charge or not.
Please note that our refraction fee is $45. If you know this charge will not be paid by your insurance carrier we ask that you make the payment at the time of service. If you have any questions about refractions, please don’t hesitate to call our office.
[ top ]
Its been just over a month since I underwent the LASIK procedure
performed by Dr. Packer to correct my nearsightedness. I am not exaggerating
when I say my life has been changed forever.
When I left the office immediately after the surgery and
could read the stop sign across the street, I knew something incredible
had happened to me. I could go on about the many areas of my daily life
that have been impacted by this simple procedure and the joy I have
felt this month, but Id like to specifically mention two.
I have not been able to swim with clear vision since the
age of twelve. A couple of weeks after the surgery I went to a birthday
party at Splash! in Springfield and, for the first time in 22 years,
enjoyed a day of playing in the water without a care in the world. I
was a kid again and it felt great.
As a lover of nature, the sport of snow skiing has become
an important activity for my overall sense of well-being. However, in
cold temperatures eyeglasses would freeze to my face and my contacts
would stick to my eyes. After LASIK, this winter Ive been able
to fully enjoy the experience of skiing visually unencumbered for the
very first time.
I will never take for granted the miracle of being able
to see clearly now. What Dr. Packer and your staff have done for me
has been a blessing in ways too numerous to count. The only way I can
thank you is to proudly share my story with others. [ top ]
was a blur without contacts before my LASIK surgery with Dr. Fine.
I decided to have monovision LASIK surgery and now I couldnt
be happier. This past Saturday I not only saw the Ducks win but
I could also see the lines on the field and read the program! It
was also great to be able to read the players numbers as they
contributed to a Duck victory. I just wanted to thank you for a
wonderful experience. [ top ]