Seeing the Light
August 2017
by Theodora Malison

ACCORDING TO THE AMERICAN ACADEMY OF OPHTHALMOLOGY, THE PREVALENCE OF DRY EYE SYNDROME INCREASES WITH AGE. An estimated 3.2 million women age 50 and over and 1.68 million men age 50 and over are affected by dry eye syndrome. With an American population living longer, this staggering number is not set to decrease in the near future.

Fortunately for those experiencing any of the irritable symptoms of dry eye and vision impairment, residents of the Greater Philadelphia area and beyond can turn to Dr. Sanjay Kamat, D.O., of Bucks Eye Specialists for answers and relief. Suburban Life/Philadelphia Life sat down with Dr. Kamat to learn more about patient treatment, much sought out relief, and recent innovations in technology.

As you’ve mentioned in the past, dry eye impacts a number of people. Over the years, how has the technology evolved in the ways of which you treat or diagnose dry eye?
Dry eye used to be a fairly glazed over diagnosis and treatment years ago. If you had a patient who had clinical findings or complaints consistent with dry eye, then you offered artificial tear therapy and/or punctal plug therapy to increase the moisture content of the eye. Then, Restasis hit the market about 15 years ago and changed everything, showing that low to high grade inflammation was present in many dry eye sufferers. Fast forward to this decade however, and we now have clinical lab tests to determine the type(s) of dry eye that a patient suffers from. We have prescriptive eye drops, supplements, eyelid wipes and cleansers, heat therapies, Intense Pulsed Light Therapy (IPL) and Lipiflow.

For those who are unfamiliar, can you explain the process of Osmolarity testing, Inflammadry and Meibomian gland testing?

Each test is performed simply and painlessly in the office:

¦ Osmolarity testing comes from a company named TearLab. We merely take a small sample of tear from both eyes and we numerically measure the salt content of the tear film in a few minutes. Very simply put, the higher the salt content number, the drier the eye is because there is less volume of tear liquid. This helps us in determining which patients need more volume of lubrication in their eyes.

¦ Inflammadry comes from a company named RPS. This test also requires a small sample of tear from the eye and in about 10 minutes, provides an answer of whether there is any true ocular inflammation. It tests for a genetic marker MMP-9 signifying true inflammation seen elevated in the tear film of patients with dry eye disease.

These two tests are billable to insurance companies and require the office to obtain certification for a clinical lab license.

¦ There’s also Lipiscan, which is a free service to our patients for Meibomian gland testing, where a specialized camera takes a photo of the inside of the eyelids and depicts the anatomy of the meibomian glands. The meibomian glands are critical in producing meibum, an oil to help lubricate the eye, somewhat similar to an emollient cream, if you will. Meibomian Gland Dysfunction (MGD) is now being implicated in more than 80 percent of patients suffering from dry eye. The basic concept here is that if the glandular material has thickened and cannot be normally “pumped” out of the glands, the glands stagnate and stop functioning properly, and finally, will die off.

With all of these technologies available in the office to help dry eye, we can prescribe or direct patients to the appropriate therapeutic options, including artificial tear supplementation, omega 3 supplements, lid cleanser, prescription eye drops, IPL and/or Lipiflow.

You’ve also mentioned you offer refractive surgery to patient. What exactly is refractive surgery and what does it correct?
Refractive surgery covers a lot of possibilities. Treatments now exist for myopia (near-sightedness), hyperopia (far-sightedness), astigmatism and presbyopia. Refractive surgery options include PRK, LASIK, LASEK, Epi-LASIK, Implantable Contact Lens (ICL), Kamra and Raindrop Lens Implants for both presbyopia correction and cataract surgery.

What types of patients do you see that usually undergo refractive surgery? Are there particular requirements that have to be met in order to qualify for refractive surgery?
For typical vision correction including PRK and LASIK, there are four basic parameters that are followed, including age, refractive error, corneal thickness/topography, and pupil size. As a general rule, younger patients, but over the age of 18, near-sighted, thick/regular corneas and smaller pupil size patients are better candidates. Any of these parameters that change more and more will potentially affect the quality of results, but it’s not to say something cannot be done.

How long is the typical recovery process for a patient who has undergone any of these surgeries?
LASIK patients generally recover the fastest, with immediate visual improvement and complete healing around two to four weeks. PRK patients wear a bandage contact lens for about a week and have to stay on drops much longer, less frequently dosed over time, but can last anywhere from two to three months. Cataract surgery patients are on drops for about a month as well. Most patients see better one day after surgery and are more or less visually stable by about one to two weeks.

Have any of these procedures changed over the years in regards to technology, recovery time, etc.?
Everything has improved significantly over the time, and the most dramatic improvement is with cataract surgery. Our capability of calculating implant lens powers and manufacturing them for a premium experience with astigmatism correction, multi-focal and/or accommodative options have tremendously improved patient outcomes as well as expectations. A fairly short time ago it was still acceptable and even desirable to merely remove the cataract without complications and fully correct the vision with bifocals afterwards. Now, if there is patient desire and all testing parameters are stable, then vision even better than 20/20 is possible without glasses after surgery now. Additionally, the newest excimer laser for refractive surgery is allowing more patients to qualify for PRK and LASIK now than ever before with larger amounts of prescription.

For those that may opt out of surgical or corrective procedures, can you describe the premium lenses you mentioned?
There are a wide range of implant lenses available, including:

¦ Standard monofocal implant lenses: Patients may require some prescription at a distance, but mostly for reading.

¦ Astigmatism Correcting Lenses: Better uncorrected (without glasses) vision at either distance or near, need glasses for one or the other.

¦ Multi-focal Lenses (Tecnis multifocal or Restor): Very good unaided vision at all distances—distance, intermediate and reading. Diffractive or extended range of vision lenses that work very well, and are sometimes associated with some night glare initially, but usually subsides over time.

¦ Multi-focal/Astigmatism (Abbot Symfony): A combination of the previous two. ¦ Accommodative Lenses (Crystalens/Trualign): Lens actually moves inside the eye to change focal point, with oftentimes less glare, but can undercorrect near vision.

Are there any other options or particular medications you offer to patients to treat chronic dry eye symptoms?
Typical eye drop therapy includes artificial tears, and there are many to choose from depending on specific patient needs. Others include topical anti-inflammatories such as steroids and nonsteroidal drops, Restasis and Xiidra.

Bucks Eye Specialists
Bucks Eye Specialists
301 Oxford Valley Road, Suite 801-A
(215) 493-7330

Published (and copyrighted) in Suburban Life Magazine, August, 2017.