NEWSLETTER -SPRING 2004
Mr. Lund's Eye
For several years we have been able to offer our patients
refractive surgical procedures to correct nearsightedness, farsightedness,
and astigmatism. Until recently, however, we did not have an effective
surgical procedure for addressing presbyopia
(the inability to focus for near vision).
Accommodation is the process whereby
we can re-focus our eyes when looking from an object in the distance
to objects at near. It is an active process and although the muscles
remain capable in middle age, the lens becomes thick, inelastic,
and does not respond to accommodative effort.
Humans are naturally
able to accommodate until around age 40 or 45, after which time
they usually require bifocals. One method for accomplishing spectacle
independence is to correct one eye for near and the other eye for
distance, but this deprives the patient of full binocularity and
depth perception. Another method is to implant multifocal intraocular
lenses (IOLs) which may simulate accommodation.
Now, for the first
time, we have an accommodative intraocular lens available, the
CrystaLens™. During focusing effort by
the patient, the position of the IOL within the eye changes, altering
its power and adding effective bifocal power without the use of
spectacles or other optical devices.
Drs. Fine, Hoffman and Packer
participated in the FDA-monitored clinical trials of the CrystaLens™ here
in America, performing 25% of the procedures comprising the investigational
study. All of the patients in whom we implanted this lens in both
eyes were capable of driving and reading a newspaper without glasses.
Throughout America, approximately 73 percent of the patients with
binocularly implanted CrystaLenses™ have
achieved almost com-plete spectacle indepen-dence. The remaining
27 percent of patients use glasses on occasion— almost exclusively
for prolonged reading.
We have recently experienced a surge in the
number of patients opting for refractive lens exchange surgery with
this new IOL. The procedure itself is exactly the same as a cataract
extraction except that in most cases the patient does not have a
clinically significant cataract. In fact, these patients usually
have completely clear lenses. After surgery, the CrystaLens™ settles
into its proper position before active focusing begins. This normally
takes 10 to 14 days, after which we do the same surgery on the fellow
We have had superb results thus far and are pleased to be able
to offer this surgical modality to patients who want correction
of nearsightedness, farsightedness, and/or astigmatism and the
ability to focus for near vision as well. If you have any questions,
please contact Tony Reynolds at (541) 687-2110 or (800) 452-2040
to set up a free consultation. [ top ]
|Mark Packer, M.D
No one Refractive Surgery modality is appropriate for all patients.
While nearsighted patients may do exception-ally well with LASIK,
farsighted patients over 45 undoubtedly do better with Refractive
Lens Exchange. And though LASIK can correct a broad range of refractive
errors, there are limitations such as very high degrees of nearsightedness
and patients with pre-existing corneal disease. To address these
limitations exciting new technology will soon become available,
phakic refractive implants. Our participation in the FDA monitored
clinical investigation for these devices over the past several
years will allow us to offer our very nearsighted patients the
experience and expertise they have come to expect from our practice.
To understand phakic refractive implants one first needs a bit
of vocabulary. “Phakic” (fay-kick) means that the natural,
crystalline lens remains untouched in the eye. The Implantable
Contact Lens (“ICL,” STAAR Surgical, Monrovia, CA)
is placed behind the iris, while the Artisan/Verisyse Lens (Advanced
Medical Optics, Santa Ana, CA) is placed in front of the iris.
Both correct nearsightedness. Other models currently under investigation
include lenses to correct farsightedness and astigmatism.
is inserted into each eye during a quick outpatient procedure.
Patients see well immediately, so there is minimal down time.
Implantation can be combined with correction of astigmatism with
small incisions in the cornea to enhance the results. Although
the implant is designed to remain permanently in the eye, it can
be removed or exchanged.
Excellent quality of vision is one of the major benefits of phakic
lenses. Because neither the cornea nor the lens is altered, the
natural optical system of the eye remains intact. These implantable
lenses function just like contacts, without any of the “care
and handling” required by contact lenses. They also represent
an option for patients with dry eye problems because they don’t
rest on the surface of the cornea like contact lenses. While wearing
contacts may be difficult because of irritation, an implantable
lens will not be felt at all.
We look forward to making these lenses
available soon. Please contact Tony Reynolds at (541) 687-2110
for further information. [ top ]
One of the newest break-throughs in refractive surgery has been
the introduction of wavefront customized excimer laser surgery.
Wavefront analysis utilizes special equipment to measure the
overall optical system of the eye and allows for treatment of
both lower order and higher order refractive errors.
Richard S. Hoffman,
order errors or aberrations include near-sightedness, far-sightedness,
and astigmatism. We have been treating these lower order aberrations
for years with LASIK. Higher order aberrations constitute a
very small percentage of the overall optical system in most patients
and usually do not need to be addressed at the time of refractive
surgery. However, there are a small number of patients who
do have significant amounts of higher order optical aberrations
that would benefit from customized treatments utilizing wavefront
Until recently, we have not had the ability
to treat these higher order aberrations such as coma, trefoil,
and spherical aberration. Higher order aberrations can degrade
the quality of vision especially in the presence of enlarged
pupils such as occurs at night. Patients who do have large
degrees of higher order aberrations might ultimately be able
to achieve postoperative visual acuities better than their preoperative
vision with glasses or contacts.
some patients with very large pupils and large refractive errors
might be less likely to develop visually significant higher
order aberrations following LASIK if treated with wavefront adjusted
We are now routinely evaluating all of our refractive
surgery patients with wavefront analysis to determine if they
are candidates for this new technology.[ top ]
Dr. Fine was recently honored to learn that he has been nominated
as one of the Medical Device and Diagnostic Industry’s
100 Most Notable People. In addition to being an accomplished
surgeon, Dr. Fine spends many hours designing and refining new
surgical instruments for cataract surgery, and he was nominated
because of his creativity and inventive nature in this endeavor.
Earlier this year, he was again listed in the “Best Doctors
in America” publication for the years 2003-2004.
was also thrilled by the recent recognition of his video entry
in the video film festival at the annual meeting of the American
Society of Cataract and Refractive Surgery (ASCRS). His video
entitled, “Innovative Spin-offs of Bimanual Technique,” was
first runner-up in the “In-house Productions” category.
Finally, Dr. Fine was further honored at the ASCRS meeting when
he was presented with the President’s Council Leadership
Award for 2003-2004 from the Outpatient Ophthalmic Surgery
Earlier this year, Dr. Packer was invited to become
a member of the Cataract Subcommittee of the Annual Meeting
Program Committee for the American Academy of Ophthalmology
(AAO). As a member of the Cataract Subcommittee, Dr. Packer
will review abstracts submitted to the AAO to determine whether
they are acceptable for presentation at the AAO annual meeting.
Dr. Packer is delighted to be able to help shape a scientific
program that will be informative and well received by annual
meeting attendees. Dr. Packer was also recently appointed as
a delegate for the Oregon Medical Association.
has been spearheading several publication efforts for Drs.
Fine, Hoffman and Packer. These include such articles as “Bimanual
technique effective for recurrent hyphema,” published
in Ophthalmology Times, “Refractive lens exchange as
a refractive surgery modality,” Current Opinion in Ophthalmology,
and “The light adjustable lens,” which is a chapter
in the book, Phacoemulsification, 3rd, published in India.
we were all thrilled to learn that Laurie Brown, COMT, COE,
our practice administrator, has been appointed as the Joint Commission
on Allied Health Personnel in Ophthalmology (JCAHPO) Commissioner
of the American Society of Ophthalmic Administrators (ASOA).
JCAHPO is the international certifying agency for ophthalmic
personnel and Laurie was elected to the ASOA Board last year.
She was also voted Vice Chair of the National Board of Certified
Ophthalmic Executives (NBCOE). Laurie is honored to serve these
agencies that have so greatly enriched her professional life.
Congratulations to all! [ top ]
In February we welcomed Amber Ambrozaitis, COA
(formerly Hargreaves), back to our practice as an ophthalmic
technician. Seeking further education in retinal photography,
Amber left our practice in spring of 2003 to work in the Special
Procedures and Testing department of the Oregon Eye Institute.
While grateful for the opportunity to learn and gain new insights
into her role as an ophthalmic technician, Amber returned to
our practice because she missed the one-on-one interaction with
our patients. She is excited by her ability to use and share
her experiences from the Special Procedures department with all
of our technicians. Welcome back, Amber! [ top ]
| Gregory N. Lund
For the past several years I have been contemplating
doing something to correct my vision. I conducted extensive research
on the variety of treatment options available and opted for Refractive
Lens Exchange, which would, in addition to correcting my vision, eliminate
the need for cataract surgery in the future. I also learned that the
newest type of lens (CrystaLens™) would correct my near vision
so I would no longer need to use reading glasses. As to who should
do the procedure, that was easy. Throughout my research the name Dr.
I. Howard Fine kept appearing. He was one of the principal investigators
in the FDA-monitored clinical trial of the lens, and he is one of a
select few ophthalmologists in the US performing this procedure. Best
of all, he was right here in Eugene.
Prior to surgery, I met with
Dr. Fine and his staff who conducted the most thorough eye exams I
have ever had. His staff was extremely courteous and professional,
making the experience quite pleasant. The actual surgery was almost
a let down; it was so easy and absolutely painless, taking only an
hour. There was a tremendous improve-ment in the operated eye immediately.
Two weeks later, the second eye was done. It has now been a month and
I can see without glasses for the first time in my life. As the Chief
Driving Instructor for the Oregon Region of the Sports Car Club of
America, I have always had to put up with wearing glasses inside my
helmet, and many times they fogged up, causing some anxious moments
at very high speed. Now that has all changed due to the wonderful results
I have absolutely no reservations in recommending this procedure. Dr
. Fine and his staff provided thoroughly professional, gentle care.
I have a feeling that I am going to be the first of many who opt for
this procedure. [ top ]
Kelley “Minty” Morris
I am writing in praise of my recent LASIK eye surgery
and Dr. Fine. Let me start by saying I am someone who doesn’t
even like to have my blood drawn. Despite my nervousness, I went ahead
with the LASIK
procedure to correct my astigmatism and nearsightedness
and I am so glad I did. The surgery is painless, fast and life changing.
I found Dr. Fine and his entire staff to be professional, quick and
Just 8 hours after my surgery I was already seeing very
clearly. The next day my vision was perfect and I even made the drive
back to Klamath Falls. I would highly recommend Dr. Fine and LASIK.
[ top ]
| Billie Brown
Ms. Brown started wearing glasses at age 7 and she hated
them because they slipped down her nose and weren’t comfortable.
In her teenage years she began wearing hard contacts which were somewhat
uncomfortable but better than wearing glasses. She eventually started
wearing soft lenses, and then multifocal contact lenses which never
seemed to fully correct her vision. Later she found she could only
wear the contact lenses for 6 to 8 hours at a time. Being a teacher
she wanted the freedom from glasses so she could concentrate on her
Forever looking for a better solution to correct her
vision she heard about LASIK. She came in for a LASIK screening and
found that LASIK wouldn’t give her all ranges of vision which she desired. Dr.
Fine explained another option to her-the ARRAY
multifocal lens implant.
She welcomed the possibility of seeing near, intermediate and far away
without glasses or contact lenses. Now its 4 years later and she is
seeing great. “This was a gift,” said Ms. Brown. She’s
working on research projects more now than ever and is more physically
active since her eye surgery. “I wish my ear doctor’s devices
would advance as much as my eye doctor’s devices.” [ top ]