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 fact.

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 lasers.

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. [ top ]

Straightforward Advice for Crossed Eyes
By Mark Packer, M.D.

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.

The 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.

People 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.

For 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 ]

---

Richard S. Hoffman, M.D.

A Rude Awakening
By Richard S. Hoffman, MD

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.

Epithelial erosion of the cornea

Recurrent corneal 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 ]