SUMMER 1993 ISSUE ■ SINAI HOSPITAL
Center for Ophthalmic Research and
Developmed Breaking Ground
esearch has been an important
tradition at Sinai Hospital since
its opening in 1953. The De-
partment of Ophthalmology
continues this legacy through its research
division, the Center for Ophthalmic Re-
search and Development. Through a
number of national research activities,
the center investigates early detection of
eye disease and treatment options for a
variety of vision problems.
Under the guidance of Joseph Rosen-
shein, Ph.D., Director of Ophthalmic Re-
search, a study is currently being
conducted to aid in early detection of
glaucoma. The study is seeking volun-
teers over the age of 35 with normal vi-
sion and no family history of glaucoma.
Traditionally, by the time glaucoma has
been detected, 25 to 50 percent of the eye
nerves have already been damaged," ex-
plains Dr. Rosenshein. "We're trying to
reduce this trend — and early detection
is the key."
Other studies at Sinai's Center for
Ophthalmic Research focus on the de-
velopment and use of state- of-the-art
equipment such as a multiple wave
length scanning laser ophthalmoscope.
"There are only two of this type in the
country and Sinai has one of them," says
Dr. Rosenshein proudly. The scanning
laser ophthalmoscope permits a specific
part of the retina to be tested precisely.
This new tool will allow ophthalmologists
to test and treat only the areas of the reti-
na that need treatment.
`Through each study conducted here,
Sinai continues to build a strong region-
al and national reputation which bene-
fits each one of our patients."
Sinai Eye Consultants Offering
the Latest Techniques
Ophthalmic conditions such as glau-
coma and cataracts require the most ad-
vanced treatment. Such treatment is
available through the Sinai Eye Consul-
tants, a group of ophthalmologists locat-
ed on the Sinai campus offering
state-of-the-art care to treat these prob-
Sinai Eye Consultants treat all dis-
eases of the eye including cataracts, glau-
coma and retinal problems, perform
refractive surgery and are responsible
for 800 ophthalmic laser procedures each
year at Sinai.
Eye Clinic Providing
Education and Care
Another important component of the
Sinai tradition is a commitment to edu-
cation. In the Department of Ophthal-
mology, this is fulfilled in the Eye Clinic
where ophthalmology residents provide
all levels of eye care.
On the Fore-
front of Med-
facts or glasses. If patients
are content with the way
their vision is currently be-
ing corrected, I tell them
RK isn't for them."
Quick and Painless
Radial keratotomy is rel-
atively painless and is per-
formed on an outpatient
basis in about one hour. Its
goal is to flatten the cornea
so that light rays reflect di-
rectly on the retina. Pa-
tients are awake during the
procedure which uses anes-
thetic eye drops to fully
numb the cornea. One eye
is done at a time.
Number of Incisions
Depending on the degree of
your myopia, you may have
4-16 incisions. The more
myopic you are, the more in-
cisions are needed.
Incision depth may vary
since your cornea is thicker
near the outer edge. The
pachymeter helps determine
Your cornea continues to
flatten after the actual
surgery. It may be a number
of weeks before complete
correction is achieved.
Normal Lens -
Q inai's Laser Refractive
In a normal, healthy lens light
rays are able to enter the eye.
Li Center is in the midst of
a two-year study of a revo-
lutionary alternative to tra-
ditional refractive surgery
to treat myopia (near-sight-
edness) and astigmatism
(irregular surface of the
cornea). Sinai is one of only
20 sites in the United
States and the only site in
Michigan participating in
the Federal Drug Adminis-
tration (FDA) study of the
Excimer laser to treat these
Laser refractive surgery
is a procedure in which a
laser is used to remove tis-
sue from the front surface
of the eye in order to re-
shape the eye's contour.
This procedure can help cor-
rect both near-sightedness
and astigmatism. The goal
of the surgery is to reduce
or eliminate the need for
glasses or contact lenses.
RK Spells Freedom From Glasses and Contacts
A sk someone who wears to reduce or eliminate near-
...glasses or contacts sightedness or astigmatism.
what they dislike most
RK was first developed
- about having to wear them by a Russian physician in
and you'll hear everything 1974 and since then the re-
- - from: "If my glasses would sults of over a half-million
only stay on my nose, they cases of RK have been ex-
wouldn't be so bad," or "My tremely positive with an ex-
I) contacts just seem to be ir- ceptionally low complication
ritating my eyes more and rate. There are currently
more." And who can forget 12 ophthalmologists at
the childhood taunts of Sinai who perform RK.
"RK is a proven, estab-
So what are the choices lished alternative to glass-
beyond glasses and con- es and contacts," says
) tarts? For many people, the Martin Apple, M.D. But it's
answer may lie with a pro- not for everyone. Dr. Apple
cedure called radial kera- explains, "RK is for patients
totomy or RK. RK is a who want to free them-
surgical procedure designed selves from wearing con-
Pursue Excellence in
Viewing through a sur-
gical microscope, the eye
surgeon makes spoke-like
micro incisions to flatten the
shape of the cornea so that
light rays focus directly on
the retina. Precision con-
trol is maintained over the
length, depth and spacing
of the incisions in order to
achieve the proper optical
correction. After the sur-
gery a patch is placed over
the eye for 12 hours. In the
days following surgery, vi-
sion steadily improves.
Do Your RK
`There are plenty of oph-
thalmologists out there who
perform RK," says Dr. Ap-
ple. And while the RK pro-
cedure hasn't changed
much over the years, what
does change is the eye sur-
Apple's advice to pa-
tients seeking an RK spe-
cialist is simple. "Do your
homework," says Dr. Apple.
"Look for an ophthalmolo-
gist with solid experience.
Sinai doctors have been do-
ing RK since 1987 and it's
that experience which sets
Sinai RK specialists apart
from the rest."
Peripheral cataract is a cataract
that is only on the edges of the
lens. At this stage, vision is not
limited and light is still able to en-
ter the eye
Dense Nuclear Cataract
When a dense cloud forms over
the center of the lens, light is not
able to penetrate the eye and vi-
sion worsens. Dense nuclear
cataracts must be treated and the
ach year approximately one million people are treat-
ed for cataracts. Cataracts occur most often in peo-
ple over the age of 60. As the eye lens loses its
transparency, vision becomes blurred. Traditional treat-
ment involves removal of the clouded lens with preci-
sion diamond-tipped instruments and the insertion of
an artificial lens. Most cataract surgery today is per-
formed on an outpatient basis. It is also one of the most
successful surgeries performed in the United States. Pa-
tients may ask then, "Why try to improve something
that's already effective?"
Maybe it's because "Sinai ophthalmologists are nev-
er satisfied," says Sheldon Stern, M.D. 'We're always
looking for better ways to do things." Sinai ophthal-
mologists and researchers continue to seek more effec-
tive ways of removing cataracts.
To decrease visual distortion after cataract surgery
Sinai ophthalmologists are experimenting with astig-
matic keratotomy, a procedure that uses tiny incisions
in the cornea at the same time as the cataract surgery.
Foldable implants, which are nearing Federal Drug Ad-
ministration (FDA) approval, have also been researched
by Sinai. The foldable implants require smaller inci-
sions. And smaller incisions result in improved visual
acuity after surgery.
In addition, Dr. Stern is looking at the clinical appli-
cations of using the Erbium laser to remove cataracts.
Lasers can remove cataracts but the procedure hasn't
been perfected yet. The Erbium laser, however, holds
a great deal of potential because it actually vaporizes tis-
sue. "This is just the beginning of Erbium laser research,"
says Dr. Stern enthusiastically.
Sinai Ophthalmologist Gary Bergman, M.D., agrees.
Since 1976 Sinai has used phakoemulsification to re-
move cataracts. Phakoemulsification, a procedure which
uses ultrasound waves to liquefy the center of the
cataract, is now being embraced by ophthalmologists
worldwide as an effective way to remove cataracts.
"Phakoemulsification allows us to make smaller, more
water-tight incisions that require few or no sutures. That
means less inflammation, faster healing and fewer re-
strictions after surgery. The procedure also lends itself
well to the use of foldable intraocular lenses," explains
The procedure has improved to the point that surgery
can now be done before the cataract "ripens," or the cen-
ter of the cataract hardens.
'We are taking cataract surgery to a new level. As we
look for ways to improve cataract surgery, we never lose
sight of the fact that what is most important is the qual-
ity of our patients' eyesight to their lives. We don't do
our research in a vacuum," says Dr. Stern.
Cataract surgery has, indeed, come a long way. At
Sinai, ophthalmologists and researchers are taking it
a few steps further.