NEWSLETTER -SUMMER 2004
|Our optical shop is converted into a lecture
hall for the didactic lecture portion of the course.
In the last weekend of August 2004, Drs. Fine, Hoffman and Packer
provided at the Oregon Eye Surgery Center, a course on the newest
technique in cataract surgery: bimanual micro-incision phacoemulsification.
This is a technique that allows for the removal of a cataract through
incisions as small as 1.2mm and is an extremely exciting and rapidly
evolving technology. This is the second course that we have done,
the first being a year ago, and both were attended by at least
30 physicians from all over the United States.
It is interesting
to note that although these physicians were coming to learn of
this technique, bimanual micro-incision phacoemulsification has
been used by Drs. Fine, Hoffman and Packer almost exclusively
for two years. In addition to refining and expanding the indications
of the technique itself, we have been responsible for developing
most of the instrumentation and optimizing the technology used
for cataract surgery right here in our own Oregon Eye Surgery
Center. We have been at the cutting edge of cataract and refractive
surgery for almost 20 years and were investigators on most of the
technology that is currently being used. These new innovations
have created a miraculous procedure out of cataract surgery compared
to what it was 20 years ago in the way of inconvenience and post-operative
visual disability for weeks prior to the prescription of glasses.
We have been core clinical investigators on each of the improvements
in intraocular lens (IOL) technology in America including the
first small incision lenses that reduced the size of the cataract
incision and dramatically reduced surgically induced astigmatism.
We have participated in all of the new material studies that
have shown improved biocompatibility of IOL materials as well
as in all of the design modifications that have led to better
stability and improved or enhanced vision.
|Dr. Fine instructs Dr. Allan Rutzen of
the University of Maryland on bimanual micro-incision phacoemulsification.
We investigated the
first multifocal and accommodative lenses as well as other categories
of lenses including the new Tecnis IOL which corrects for spherical
aberrations. We have also been core investigators and have participated
in the development or improvement of all of the phacoemulsification
equipment manufactured within the United States. Each of these
individual changes were small at the time, but it is through
these incremental improvements over a period of 20 years that cataract
surgery has become a procedure that is minimally invasive, rapidly
rehabilitative and enormously safe.
In addition, we have designed more than 30 instruments that are
used world-wide for cataract surgery and/or intraocular lens
implantation. We have also innovated over 20 surgical procedures
or components of the cataract surgery that are, at this time, utilized
by almost the majority of ophthalmologists world-wide. The Oregon
Eye Surgery Center, the surgery center within our clinic, has
more cataract surgery technology than any hospital or medical school
in the world. Surgeons and other medical personnel come from
all over the world to observe our surgical techniques, instrumentation
and technology. It is hard to believe this is true when you consider
the size and location of our fair city, but this is an actual
Our emphasis on innovations and participating in new investigational
studies has been an enormous advantage for our patients because
they have access to enhanced technology and techniques as early
as four or five years ahead of the rest of the country. We are
pleased to continue this tradition by being the first site in
the United States of America to offer an investigational laser,
the MEL-80 laser manufactured by Carl Zeiss Meditec, which after
our initial use appears to be superior to the currently used
Drs. Fine, Hoffman and Packer take great pride in providing
new and improved techniques, technology and devices that have
enriched the lives not only of our patients, but of the millions
of patients around the world whose surgeons have come to Eugene,
Oregon to learn about these techniques and to bring them home to
their own patients.
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|Mark Packer, M.D
Everyone who has taken a public speaking course or learned interviewing
skills has heard the importance of eye contact in communication.
When we “look each other in the eye” we share a myriad
of both conscious and subliminal clues about meaning and intention
that condition our responses. Unfortunately, many people cannot
look each other “straight in the eye” through no fault
of their own: they have eyes that simply won’t cooperate
with what they want them to do. These people have a condition known
to ophthalmologists as strabismus.
Strabismus is a Greek word meaning
squint, and the word we apply to disorders of ocular alignment.
A large variety of disorders exist, from eyes that turn in towards
the nose to eyes that wander out towards the ear. Other eyes drift
upwards towards the sky, while some don’t seem to want to
go in any direction but back inside the lids.
Fortunately most of these conditions are
amenable to treatment. One common condition, an eye that begins
to turn inward in children when they are about 2 to 4 years old,
can be corrected with glasses. These kids are very farsighted
and when they use the muscles inside the eyes to focus their eyes
also converge, or turn inward. Fixing the farsightedness with glasses
also fixes the inward turn.
most common cure for eyes that won’t line up is surgery.
Adults can have these procedures with local anesthesia. Another
advance in surgery for strabismus is the use of adjustable sutures.
These allow the surgeon to make minor adjustments in the position
of the eye the day after surgery and increase the success of the
procedure. The recovery period is from one to six weeks.
really are profoundly happy when they see themselves for the first
time with straight eyes. The psychosocial aspects aside, some adults
with strabismus suffer from double vision. The correction of this
debilitating problem can make a dramatic improvement in someone’s
life. Not all patients enjoy a perfect result, however, and the
odds of a cure drop if there has been extensive prior surgery that
involves scarring of the eye muscles. These cases are more difficult
to perform and the outcome is less certain.
children the correction of strabismus is urgent because the visual
system is still developing and the brain will suppress the image
from a turned eye, creating a lazy eye (amblyopia). After about
the age of 8 it becomes very difficult if not impossible to make
a lazy eye work. At younger ages patching the stronger eye or
using an eye drop to blur the vision in the stronger eye will force
the lazy eye into action, but the younger the child the easier
the condition is to treat.
If you or a family member
is troubled by strabismus, please feel free to schedule a consultation,
(541) 687-2110. [ top ]
An abrasion of the corneal surface is a painful event. Under
most circumstances, these abrasions of the corneal surface will
heal within several days without any permanent loss of vision.
In rare instances, patients can develop recurrent painful episodes
in eyes that have had abrasions. These episodes tend to occur
in the middle of the night or upon wakening in the morning and
can last several hours or rarely several days. When this condition
develops it is termed a recurrent corneal erosion.
| Richard S. Hoffman,
of the cornea
erosions result from poor adhesion of the cornea’s
outer most surface (corneal epithelium) to the underlying corneal
tissue. The corneal epithelium is normally adherent to the underlying
layer of the cornea by anchoring structures that are broken when
an abrasion develops. These anchoring structures will reform
within several months, however, if recurrent erosions develop,
the epithelium is not able to form these anchoring structures.
This occurs when the eyelid sticks to the epithelium during sleep
followed by pulling of the epithelium off of the cornea with
REM (rapid eye movement) or upon opening the eyes when wakening.
Older patients with dry eyes are at greater risk for developing
erosions but they can happen to anyone. There are also pathologic
conditions of the cornea that can make individuals prone to erosions
without ever having had an abrasion.
There are various treatments
for this condition. The simplest and least invasive management
involves the use of lubricating ointments throughout the day
and especially at bedtime. Bland lubricating tear ointments or
sodium chloride (salt) eye ointments work well for this purpose.
If a patient can keep their eye lubricated every day and allow
the epithelium to create those anchoring structures without getting
pulled off, then the condition will usually be cured. When this
fails, minor surgical techniques can be employed with great success. [ top ]
|Dr. Packer discussed IOL power calculations
in Fukuoka, Japan.
Drs. Fine and Packer were delighted to continue their teaching
efforts around the world. Dr. Packer spoke at the annual meeting
of the Japanese Society of Cataract and Refractive Surgery on
IOL power calculations. His talks were well received and he was
treated as an honored guest. In addition to speaking in Bali,
England, and Paris, Dr. Fine was particularly honored to be an
invited speaker in a University of Oregon Anatomy and Physiology
course. He discussed how the anatomy of the eye can be changed
and reshaped to create better vision. The students were excited
by his enthusiastic presentation if not somewhat queasy by some
of the video footage demonstrating various eye surgery techniques.
Packer was recently invited to join the editorial board of
EyeWorld Magazine. EyeWorld is the official magazine of the American
Academy of Cataract and Refractive Surgery. As an already sitting
member of the EyeWorld editorial board, and a regular columnist,
Dr. Fine is delighted to welcome his partner on board. Dr. Packer
also recently graduated from the Oregon Medical Association
Leadership Development Program.
Dr. Hoffman continued spearheading
several publication efforts this summer including multiple
articles in ophthalmic journals such as the Journal of Cataract
and Refractive Surgery and Ophthalmology Times on such topics
as refractive lens exchange, pupil expander rings, and micro-incision
intraocular lenses. In addition, Dr. Packer is currently in the
process of compiling a textbook on refractive lens surgery that
should be published in early 2005. [ top ]
| Drs. Fine, Hoffman
and Packer with
Drs. Christoph Thomas
and Francisco Porfirio.
If you were in our offices in August, you met Christoph
Thomas, a medical student from Germany, who was here observing
Drs. Fine, Hoffman and Packer as part of his medical training.
Brazilian ophthalmologist, Francisco Porfirio,
MD, also observed Drs. Fine, Hoffman and Packer in August and
September of this year.
Our observership program allows physicians
like these to share the advanced techniques they learn here
with their colleagues at home to benefit patients worldwide.
[ top ]
I had LASIK in December 2003 and could not be happier
with the results. I went in seeing 20/400 and I am now 20/15! As I
told Dr. Packer, the surgery was worth 5 times the cost! My eyes are
no longer drained and tired after working at a computer all day. I
to stress out about getting make-up in my contacts or losing them
if I am skiing or scuba diving. It saves me lots of time getting
ready in the morning. Inevitably, if I was ever late for an appointment,
that would be the day that I would get a tear or dirt in my contacts!
tell all my friends to have the surgery. It was so easy, your office
was very professional yet friendly and it was quick! My only regret
is that I didn’t do it sooner. [ top ]
| Shane Johnson
I started wearing glasses at age seven.
After having the LASIK procedure, I wonder why I waited so long to
have it done. I thought at first it was for vanity, but now I realize
it also improves your quality of life. No more cleaning my glasses
and no more pushing them up on my nose. I am able to wear good sunglasses.
I can see my alarm clock. The list of improvements goes on and on.
It has been a freeing experience for me.
Dr. Hoffman did an exemplary job explaining the procedure and with
the follow up. The staff was very professional and made me feel quite
comfortable with the process.
I would recommend the procedure to anyone. [ top ]