Paul Phillips Eye & Surgery Center

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SAVE $800 ON LASIK AND GET 0% FINANCING FOR UP TO 24 MONTHS! FSA/HSA accounts welcome. One discount per surgery. Save $800 for both eyes. LASER VISION CORRECTION Our Laser Vision Coordinator may be reached at (908) 824-7144, x 125. Please call us with any questions regarding the surgery process, interest free financing options, or to schedule a no-charge consultation with one of our surgeons. LASIK All-Laser Custom LASIK is an exciting laser vision correction procedure that can dramatically reduce a patient’s dependency on contact lenses or eyeglasses. LASIK is performed to correct myopia (nearsightedness), hyperopia (farsightedness), and astigmatism. Ultimately, laser vision correction improves the eye’s ability to focus properly and enhances vision. Our surgeons use an ALLEGRETTO WAVE®excimer laser to permanently change the curvature of the cornea. Before the ALLEGRETTO WAVE®excimer laser is applied the surgeon creates a flap to reach the inner layers of the cornea using an INTRALASE femtosecond laser. Many people do not realize that in traditional LASIK this first step, the flap creation, is accomplished using a blade. While traditional LASIK is a very safe, effective, precise procedure, INTRALASE technology further reduces the risk of complications. In addition, INTRALASE extends the benefits of the procedure to many patients who were poor candidates before. As a result, patients gain a new level of confidence in laser vision correction. Now, the blade is replaced by the INTRALASE laser, making INTRALASE a truly All-Laser procedure and eliminating all blade-related complications. PRK (PHOTOREFRACTIVE KERATECTOMY) PRK (Photorefractive Keratectomy) is a laser vision correction procedure performed to improve vision and reduce or eliminate the need for eyeglasses or contact lenses. In the PRK laser vision correction procedure, the laser surgeon utilizes the ALLEGRETTO WAVE® excimer laser to reshape the curvature of the eye for patients with nearsightedness, farsightedness, and astigmatism. Photorefractive Keratectomy has been performed since 1986. Prior to LASIK, PRK was the most commonly performed laser vision correction procedure. PRK differs from LASIK as no flap is created during the PRK procedure. PRK may be suitable for people with larger pupils, thin corneas, corneal issues, or dry eyes. HIGH PERFORMANCE VISION ALLEGRETTO WAVE® is capable of producing some of the largest available optical zones. The optical zone refers to the portion of the cornea that has been corrected by the laser. A larger than normal optical zone is especially important for night vision, and for patients with very large pupils. If a patient’s pupil is larger than the optical zone, they may experience poor peripheral vision, poor night vision, and a higher than normal incidence of "halos" and glare. In the past, this has been one of the biggest drawbacks to conventional laser correction surgery. PerfectPulse Technology™ represents a new approach to laser vision correction – it accounts for speed, precision, and safety in the ALLEGRETTO WAVE® laser and offers improvements that are revolutionary in the field. Smart Energy Control measures and adjusts energy levels in the laser pulse from creation to delivery. High-speed eye tracking charts the eye’s movement 200 times per second. As a result, every laser pulse is completely controlled and accurate, achieving the most accurate level of correction possible. If, at any time, the eye moves too quickly to be measured or moves out of range, the laser will stop and wait for the eye to move back into position. BETTER NIGHT VISION AND GLARE CONTROL At night and in dark conditions, the pupil becomes larger to permit the maximum amount of light to enter the eye. Laser eye correction needs to take this fact into account. If the optical zone is smaller than the size of the pupil at its largest, there is a good chance that the patient will experience poor night vision or problems with glare and halos around bright objects such as oncoming headlights. ALLEGRETTO WAVE® is able to produce the largest available optical zone, virtually eliminating glare and night vision problems associated with older generation lasers. WAVEFRONT OPTIMIZED™ LASER VISION CORRECTION One of the most innovative features of the ALLEGRETTO WAVE® is the way it uses wavefront-optimized technology to automatically compensate for the curvature of the cornea. In earlier laser correction systems, the "optical zone," or area of correction, was centered on the front of the cornea; the result was a flattened circular area that ended with an abrupt edge, causing unwanted side effects like poor night vision, glare, and halos. IS ALLEGRETTO WAVE® RIGHT FOR ME? ALLEGRETTO WAVE® expands the boundaries of candidacy for LASIK. However, there are certain people who are less than ideal candidates for LASIK.

During your examination we will discuss your surgical options and help you choose the type of cataract surgery that is best suited to your needs and lifestyle. The eye focuses images through a lens inside the eye like a camera uses a lens to focus. When we are born, the lens is clear and flexible, allowing crisp vision with a full range of focus from near to far. As we age, the lens becomes cloudy and inflexible, causing vision to blur. A cloudy lens is called a cataract. Because of the clouded lens or cataract, images may become blurry with age. Cataracts may make it progressively more difficult to read, drive, watch TV, and perform normal daily activities. Cataract formation is a normal, unavoidable part of the aging process. They cannot be prevented from forming, but early detection through regular eye exams can help maintain the clearest vision possible. There is no pain associated with the condition, but there are several symptoms that indicate failing vision due to cataracts. These include: Blurred / hazy vision Spots in front of the eye(s) Sensitivity to glare A feeling of "film" over the eye(s) A temporary improvement in near vision For people who are significantly affected by cataracts, replacement surgery may be the preferred method of treatment. During cataract replacement, the most common surgical procedure in the country, the lens is removed and replaced with an artificial one called an intraocular lens or IOL. Many IOLs are available, but most do not eliminate the need for reading glasses after cataract surgery. Please visit the Multifocal Intraocular Lens (IOL) section of our web site to read about IOL's designed to improve distance and near vision. We also offer Toric IOLs to correct astigmatism. In traditional cataract surgery, the surgeon makes incisions and removes the cataract using surgical instruments and blades. The technology used in cataract surgery has evolved over time. While traditional cataract surgery produces excellent outcomes, we are now able to offer our patients the latest technology - Laser Assisted Cataract Surgery. We will let you know if you are a candidate for Laser Assisted Cataract Surgery. CATALYS LASER ASSISTED CATARACT SURGERY Until the early years of this decade, the major steps of cataract surgery were always done using manual techniques. Blades and microscopic instruments were used to perform the first few steps of the procedure. Laser-assisted cataract surgery is a bladeless, computer-controlled laser surgery designed to improve precision, safety and accuracy. The femtosecond laser replaces the traditional hand-held blade to optimize all incisions for enhanced, reproducible surgical results. Several of the most critical steps of the surgical process are performed using an image-guided femtosecond laser. We are proud to have been among the first to bring this revolutionary technology to our area. Having used the technology for three years, we are pleased with our results and look forward to discussing this exciting option with you.

MULTIFOCAL INTRAOCULAR LENSES FOR LESS DEPENDENCE ON GLASSES Life without near vision glasses was not an option for most cataract surgery patients in the past. Even now, many patients choose to have a standard IOL implanted which will require the use of near vision glasses after cataract surgery. If you have ever wanted to reduce your dependence on reading glasses, you may be interested in a multifocal IOL. Multifocal IOLs are designed to improve both distance and near vision, giving cataract patients their best chance to live free from glasses. TECNIS® A series of rings in the Tecnis Multifocal® IOL allows for focal points at distance and near. There are Tecnis Multifocal® lenses with a range of near focal points available to allow near vision to be customized to a patients’ unique lifestyle. We are proud to be one of the first practices in the country to be able to offer the Tecnis Symfony® and Symfony Toric® IOLs to our patients. These lenses allow patients with astigmatism to have a greater independence from near vision glasses than was previously attainable. The Symfony® IOLs provide continuous, high quality vision. While reading glasses may still be required in some situations and for fine print, patients with these lenses may be able to reduce the frequency of wearing near vision glasses after cataract surgery. ACRYSOF® RESTOR® Similar to the Tecnis Multifocal®, the ReSTOR® Multifocal IOL is also constructed with a series of rings that allow for focal points at distance and near. There are two options available for near vision focal points to allow customization of near vision. ASTIGMATISM CORRECTION THROUGH CATARACT SURGERY USING A TORIC IOL AND THE CATALYS LASER LRI Astigmatism is a natural condition that occurs when the front surface of your eye, called the cornea, is shaped irregularly. This condition is usually present at birth. This irregular shape causes blurry vision because light rays are distorted as they enter the eye and can’t focus properly. Most people have some amount of astigmatism. Small amounts of astigmatism usually don't require correction during cataract surgery. However, larger amounts can cause distorted or blurred vision, eye strain and headaches after surgery if not corrected. Thanks to advancements in surgical techniques and technology, your surgeon can now permanently correct for the majority of your corneal astigmatism during cataract surgery. Larger amounts of astigmatism are corrected through the use of a Toric IOL. Smaller amounts of astigmatism can be corrected by using the Catalys laser to make microscopic incisions in the surface of your cornea. These incisions, called limbal relaxing incisions (or LRIs) can be opened, if needed, at the time of surgery. Opening the incisions changes the shape of the cornea slightly and corrects for small amounts of astigmatism, making the vision crisper. When astigmatism is corrected with a Toric lens, people are typically happy with their distance vision without glasses but do require glasses for near vision. In other words, the Toric lens gives greater independence from distance glasses following surgery for patients with astigmatism. Your surgeon will tell you whether you have enough astigmatism to require correction.

Glaucoma is the term for when the pressure inside the eye rises high enough to damage the optic nerve. The condition often develops over many years without causing pain - so you may not experience vision loss until the disease has progressed. Glaucoma cannot be prevented, and vision lost to it cannot be restored. Left untreated, glaucoma can cause blindness. For these reasons, regular eye exams and early detection are critical. The high eye pressure associated with glaucoma is caused by blockages in the eye's fluid drains. No one knows yet why the blockages form. Symptoms are occasionally present and should be taken as warning signs that glaucoma may be developing; these include blurred vision, loss of peripheral vision, halo effects around lights and painful or reddened eyes. People at the greatest risk include those who are over the age of 40, diabetic, near-sighted, African-American, or who have a family history of glaucoma. Once diagnosed, glaucoma can be controlled. Treatments to lower pressure in the eye include non-surgical methods such as prescription eye drops and medications, laser therapy, and surgery. LOW VISION SERVICES Low vision, or visual impairment, is vision that cannot be adequately corrected through traditional methods such as eyeglasses, contact lenses or refractive surgery. Classification begins with corrected vision of 20/30 in the better eye, or experiencing blind spots or tunnel vision. Patients with low vision may not be able to participate in certain everyday activities, including reading, watching television or even driving, and may require assistance from others. CLASSIFICATION OF LOW VISION Visual impairment is classified, according to the best possible correction with glasses, as follows: Mild vision loss - 20/30 to 20/60 Moderate low vision - 20/70 to 20/160 Severe low vision - 20/200 to 20/400 Profound low vision - 20/500 to 20/1,000 Near total blindness - more than 20/1,000 CAUSES OF LOW VISION Eye diseases or conditions are usually the causes of low vision. Some of them may include: Macular Degeneration Diabetic Retinopathy Stroke Retinitis Pigmentosa Albinism Retinal Detachment Cataract Glaucoma Injury Birth Defect SYMPTOMS OF LOW VISION Symptoms of low vision may include: An inability to recognize familiar faces Inability to function unless you are physically near objects Unable to match colors of clothing Inability to read outdoor signs The need for more lighting DIAGNOSIS OF LOW VISION Diagnosis of low vision is confirmed after a thorough medical examination of your eyes and may include the following diagnostic tests: Visual acuity examination Dilated eye examination Refraction TREATMENT OF LOW VISION Patients with low vision can experience effective visual assistance through low vision aids such as magnifiers, telescopes and video magnifiers. Large print text, audio tapes and special lighting can also help improve vision for these patients. It is important for patients with low vision to have their eyes tested regularly, as low vision may be the first sign of serious eye conditions.

There are many diseases that can affect the cornea, causing pain or loss of vision. Disease, infection or injury can cause the cornea to swell (edema) or degrade (become cloudy and reduce vision). Common diseases and disorders include: Allergies Bullous Keratopathy Conjunctivitis ("Pink Eye") Dry Eye Corneal Dystrophies including Fuchs' Dystrophy Glaucoma (High Eye Pressure) Infections Keratitis (Viral Inflammation) Keratoconus Ocular Herpes Pterygium Shingles (Herpes Zoster) Recurrent Erosion Syndrome (RCE) DRY EYE Dry eye occurs when the eyes are not sufficiently moisturized, leading to itching, redness and pain from dry spots on the surface of the eye. People usually begin experiencing dry eye symptoms as they age, but the condition can also result from certain medications, conditions or injuries. Dry eye is not only painful, but can also damage the eye's tissues and impair vision. Non-surgical treatments for dry eye include increasing humidity at home or work and use of artificial tears or moisturizing ointment. If these methods fail, small punctal plugs may be inserted in the corners of the eyes to limit tear drainage. WHAT IS A CORNEAL DYSTROPHY? Generally speaking a corneal dystrophy is a non-infectious, non-inflammatory gradual deterioration of one of the five layers of the cornea. Some dystrophies are believed to be hereditary, are usually bilateral, and can be progressive. There are a variety of corneal dystrophies but the two most common are Epithelial Basement Membrane Dystrophy (EBMD) and Map-Dot-Fingerprint Dystrophy (MDD). EPITHELIAL BASEMENT MEMBRANE DYSTROPHY (EBMD) Also known as Map-Dot-Fingerprint Dystrophy (MDD), a disease or anatomical defect of the cornea which affects the ability of the epithelium (outer "skin" of the cornea) to attach to the lower layers of the cornea. Instead, it grows unevenly or detaches. FUCHS’ DYSTROPHY Fuchs' dystrophy is an inherited eye disease that causes the cells in the last layer of the cornea to deteriorate, leading to distorted vision and corneal swelling. The exact cause of Fuchs' dystrophy is unknown, but is believed to be a combination of hereditary, hormonal and inflammatory factors. This condition affects both eyes and is more common in women than in men. Symptoms do not usually appear until the patient is over the age of 50. While there is no cure for Fuchs' dystrophy, there are several treatment options available to help relieve symptoms and prevent permanent damage. In its early stages, Fuchs' dystrophy can often be treated with a salt solution to remove fluid from the eye and reduce swelling. In more advanced stages patients may require a corneal transplant. KERATOCONUS Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. The cornea is the clear, central part of the surface of the eye. In patients with keratoconus, the cone-shaped cornea deflects light and causes distorted vision. Changes in the shape of the cornea occur gradually, usually over several years. Early stages of keratoconus can be treated with eyeglasses or soft contact lenses, while progressive keratoconus treatment may include rigid gas-permeable contact lenses. If keratoconus persists, corneal transplant surgery can be performed to correct the condition. PHOTOTHERAPEUTIC KERATECTOMY (PTK) Phototherapeutic Keratectomy is an advanced laser procedure used to treat corneal abnormalities such as scar tissue or an irregular surface that causes blurry vision or discomfort within the eye. PTK is ideal for corneal conditions such as: Epithelial erosion syndrome (RCE) Corneal scars Epithelial basement membrane dystrophy (EBMD) and Map-dot-fingerprint dystrophy (MDD) CORNEAL TRANSPLANT - DSAEK The cornea is the clear covering of the front of the eye which bends, or refracts, light rays as they enter the eye. The cornea must have the correct shape and clarity to focus incoming light rays precisely on the retina at the back of the eye. When the cornea becomes cloudy or misshapen from injury, infection or disease, transplantation may be recommended to replace it. Short for Descemet's stripping and automated endothelial keratoplasty, DSAEK replaces only the damaged, innermost layers of cells within the cornea, known as the endothelium, while leaving the healthy parts intact. This allows the procedure to be performed through a much smaller incision with shorter recovery times and fewer risks than a traditional corneal transplant.

YOUR BABY'S EYES: A GOOD START FOR GOOD VISION Your baby's eyes are his or her windows to the world, and to you. It is important that you protect your baby's vision as he or she grows. WHAT CAN MY BABY SEE? Newborns can see the shape of their parent's faces. By three months old, a baby can focus on objects and follow them with his or her eyes. By 6 months old, babies will use their eyes to find and focus on objects. DO I NEED TO HAVE MY BABY'S EYES CHECKED? Yes, your newborn's eyes should be checked by a pediatrician (children's doctor) or family physician in the nursery to make sure they are all right. Your baby's eyes are not like yours. They still need to grow. If both eyes are not working the right way, your baby's vision might never develop properly. It is important to have your baby's eyes examined when he or she is: A newborn 6 months old 3 ½ years old Many serious eye diseases that affect babies can be found at a very early age. The earlier they are found, the easier it is to fix the problem. Some newborns have a greater chance of having eye problems than others: Was your baby born early? Did your baby weigh less than 5 lbs. at birth? Does anyone in your family have an eye disease? Did you use drugs while you were pregnant? If you answered yes to any of these questions, then you should take your baby to a special doctor an ophthalmologist. An ophthalmologist is a medical doctor specially trained to treat eye problems. At 6 months and 3 ½ years old, your baby's eye health should be checked again by the doctor. HOW CAN I TELL IF SOMETHING IS WRONG WITH MY BABY'S EYES? Here are some signs that your baby might have an eye problem: Crossed eyes or eyes that don't line up after your baby is 2 months old Milky white or yellowish pupils (the dark circle in the center of the eye) The front of the eye looks swollen Tearing or discharge from the eye that won't go away The white part of the eye looks red A drooping eyelid Eyes that move so quickly they seem to shake or dance If you see any of these warning signs, take your baby right away to an ophthalmologist, a medical eye doctor. But remember, even if you don't see any of these signs, it's important that your baby's eyes are checked at 6 months and 3 ½ years old. REFRACTIVE ERRORS, STRABISMUS, AND AMBLYOPIA The most common difficulty children face is refractive errors, usually myopia (nearsightedness). With this condition, distant objects are blurred because the eye has too much focusing power, and light rays come to a focus before they reach the retina. Astigmatism (an optical distortion of the eye) and farsightedness (the relaxed eye does not have enough focusing power for clear distance vision) are other refractive errors children may have. Children may have difficulty seeing the blackboard at school, or the soccer ball downfield, and suffer poor performance. Fortunately, many of these children come to medical attention as they often fail school eye exams, whereupon the refractive error can be discovered and remedied with glasses. Also common amongst children is strabismus (misalignment of the eyes). The eyes may be crossed inwards (esotropia), or outwards (exotropia). When this occurs, either on an intermittent basis or on a sustained basis, each eye will see a different object causing the eye to shut down (amblyopia). The child will go to great extremes to remedy it, sometimes by changing head posture. Up to the ages of 7-9, the visual system is sufficiently flexible so as to correct the amblyopia. If one waits too long, the brain and visual system will not develop the neurological pathways needed to see with the deviated eye. In addition to strabismus, refractive errors producing worse vision in one eye can cause the child to preferentially use the other eye, causing the visual system to ignore the relatively more blurred eye producing amblyopia. While refractive errors are usually treated with glasses, strabismus is usually treated with patching of the good eye, such that the visual system is forced to use the amblyopic eye and develop good neurological pathways. PINK EYE Since children are exposed to numerous viruses during the cold season, schools and play groups are known to experience outbreaks of 'pink eye'. This condition represents a viral infection of the mucus membranes of the eye (the conjunctiva) caused by the cold/flu virus (usually the Adenovirus). Some patients may primarily have chest involvement, throat involvement (sore throat), or eye involvement ('pink eye'). The ocular involvement can range from mild to severe, consisting of redness, discharge, lid swelling, discomfort or pain. Thus the ocular infection actually represents a viral conjunctivitis.

UVEITIS - OCULAR INFLAMMATORY DISEASE Uveitis is a wide range of inflammatory diseases of the eye, specifically the uvea. There are 3 basic layers of the eye – the sclera and cornea on the outside, the retina on the inside, and the uvea in between. The uvea is comprised mostly of blood vessels and connective tissue, including pigmented cells. The different parts of the uvea are the iris in the front, the ciliary body in the middle, and the choroid located behind these, which lies around most of the eye. Sometimes uveitis can affect parts of the eye other than uvea, such as retina, vitreous, or optic nerve. TYPES OF UVEITIS Types of uveitis are based on what part of the eye is affected. Anterior uveitis – inflammation in the front of the eye, called iritis or iridocyclitis. Intermediate uveitis – inflammation in the middle part of the eye, or pars planitis or vitritis. Posterior uveitis – inflammation of the back of the eye, such as choroiditis, retinal vasculitis, retinitis, neuroretinitis, retinochoroiditis, or chorioretinitis. CAUSES Uveitis has many causes. Most cases are due to autoimmune disease or infection, and there are some for which a cause is not found – so called “idiopathic” uveitis – which is treated as non-infectious inflammation. Other causes include trauma, medication-induced uveitis, and in rare instances, cancer. SYMPTOMS These can vary by the type of uveitis, and can present in one or both eyes. Symptoms commonly include: Redness Blurry vision Pain Light sensitivity Floaters and flashes Any of the above symptoms can occur with any type of uveitis. There are even some types of uveitis that often present without any symptoms at all, such as uveitis associated with juvenile idiopathic arthritis. The first step in diagnosing uveitis is a thorough history of illness and review of systems. The importance of this cannot be overstated, and is, unfortunately, sometimes overlooked. The primary goal of treating uveitis is getting rid of inflammation as fast as possible.

BOTOX® COSMETIC BOTOX® is now the most widely performed cosmetic procedure in the United States. BOTOX® produces its effects by weakening the muscles that create wrinkles. It works in the forehead, in crows' feet, around wrinkles in the mouth and for cording (turkey gobbler!) in the neck. It lasts for approximately three to six months. BOTOX® is injected relatively painlessly using a variety of techniques right in our office. DERMAL FILLERS Dermal fillers may be used to create a more rested, youthful appearance by filling in some of the hollows of the face, such as the lines around the mouth, vertical lip lines, or even dark circles beneath the eyes. Common products used for treatment are Juvéderm®, Xeomin®, and Radiesse® injectables.

BLEPHAROPLASTY "EYELID LIFT" Upper and lower eyelid Blepharoplasty is a procedure that involves sculpture of the upper and lower eyelids. The upper eyelid crease can be recreated and made more graceful; the corners of the eye can be gently elevated if desired. The incisions are hidden in the eyelid creases, or on the back surface of the eyelid (conjunctiva), using a transconjunctival approach. If desired, the hollow beneath the lower eyelids (the tear trough) can also be filled in with fat. The procedure generally takes one to two hours. Sutures are placed that usually dissolve on their own. Postoperatively, there is surprisingly little pain with bruising that can last up to one week. Full activities may be resumed after a week. ENDOSCOPIC BROW LIFT Patients who feel they have drooping of the upper eyelids often have drooping of the brows. Brow drooping can be corrected with a procedure known as an Endoscopic Brow Lift. The brow lift is performed using a small telescope through five incisions, approximately one-half inch in size, hidden in the hairline. Patients can expect to be swollen for approximately five days. The operation is accomplished under monitored anesthesia with sedation. The procedure is often performed to remove upper eyelid skin and sculpture the fat pads in the upper eyelids (upper Blepharoplasty). The procedure is often accompanied by Endoscopic Mid-Facelift and occasionally by fat injection (lip sculpture).