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Drs. Fine, Hoffman & Sims Opthalmologists in Eugene Oregon



Refractive Surgery Reaches the Goal of Full Vision Correction
By Dr. I. Howard Fine
CrystaLens™ inside 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 eye.

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 ]

Phakic Refractive Lenses Soon Available
By Mark Packer, M.D.

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.

The lens 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 ]

Customized Wavefront LASIK
By Richard S. Hoffman, MD

Richard S. Hoffman, M.D.

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.

The lower 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 analysis.

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.

In addition, 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 corrections.

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 ]

Honors and Awards
By Sherrie Brunell, MS

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.

Dr. Fine 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 Society.

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.

Dr. Hoffman 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.

Finally, 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 ]

Returning Face

Ambrozaitis, COA

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 ]

Ready to Race Again
By Gregory N. Lund

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 from surgery.  
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 ]

By Kelley “Minty” Morris
KOTI-TV News Anchor & Reporter, Klamath Falls, Oregon

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 helpful.

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 ]

By Billie Brown

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 students.

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 ]

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