SUMMER 1993 ISSUE ■ SINAI HOSPITAL HealthNews 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- lems. 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. Laser Refrac- tive Center On the Fore- front of Med- ical History 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. RADIAL KERATOTOMY 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 Incision depth may vary since your cornea is thicker near the outer edge. The pachymeter helps determine incision depth. Corneal Flattening Your cornea continues to flatten after the actual surgery. It may be a number of weeks before complete correction is achieved. CATARACT SURGERY 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 common conditions. 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. "four-eyes!"? "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- Sinai Ophthalmologists Pursue Excellence in Cataract Surgery 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 Homework `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- geon's experience. 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." Nsinal Peripheral Cataract 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 lens replaced. E 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 Dr. Bergman. 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.