The macular is the very center of the retina and when there is damage to this area there is loss of central vision and a preservation of peripheral vision.  The important point here is that the retina surrounding the macular is healthy and functional.  If a person with macular degeneration looks at your face while standing in front of you, they will not see your eyes or nose but will see your ears because the image of your ears falls on healthy retina.  Needless to say, this is debilitating and frustrating. 

Along came VisionCare Ophthalmic Technologies, a research and development company that has developed and tested a lense that is implanted in the eye at the time of cataract surgery which magnifies the light image entering the eye by almost three times and projects an image on to the retina  outside the macular region and on to normal retina.  This lens has been studied for the last two years and it has been found that 60% of the patients had substantially improved vision with significant increases in quality of life.  They had less difficulty watching TV, recognizing family and friends, seeing facial expressions and reading large print books. 

The good news is that that this lens technology has obtained FDA approval and is now awaiting approval by Medicare.  At present this lens is approved for patients with cataracts and severe vision loss in both eyes from dry macular degeneration.  The lens is implanted in only one eye.

Here in Miami, I have been helping patients with both wet and dry forms of macular degeneration for quite some time.  To this point, there has been little to offer those with the dry type of the condition other than nutritional supplementation.  This lens represents the first significant help to come along.

If you are interested in discussing this technology and how it might be of help to you, call me at Miami Eye Center and I will be happy to bring you the full details of this exciting breakthrough.

Cosmetic eyelid surgery for the correction of drooping eyelids (ptosis) and/or baggy eyelids (blepharochalasis) does not hurt!  Not before, during or following the procedure.  That may seem hard to believe and I must agree that unless I had witnessed this phenomenon numerous times, I would not believe it either.   

Preoperative photos are taken and a plan for surgery is discussed with the patient. Firstly, during the procedure the patient is given an intravenous sedation and once asleep the eyelids are anesthetized with Novacaine and adrenaline.  When I say “asleep” I mean local sedation which wears off in several minutes unless it is repeated.  Some patients are awake enough to maintain a conversation, others prefer to “not know anything.”  Any level of sedation is possible.   The adrenaline is added to the Novacaine to shrink the blood vessels of the skin and thus reduce bleeding.

During the procedure the excess skin is removed.  I prefer to accomplish this with a radio frequency generator transfering the energy to a cutting needle.  Some refer to this as “radio-surgery.”  The incision is precise and bleeding is minimal, all leading to a rapidly healing wound with little to no scarring.  Once the skin has been removed, the underlying fat is excised, this eliminates the baggy appearance.  In general, woman require that all the fat be removed as this allows for a smooth contoured upper eyelid which makes the application of mascara and eye shadow much easier.

Lower eyelid surgery requires attention to detail.  The contour of the lower eyelid line is important as is the bagginess of the lid.  The baggy lids are due to the migration of fat from behind the eyeball to a more forward position.  The sagging lower eyelid line may be due to a weakening of the structures supporting the lid.  A fine line incision is made below the eyelashes and the fat is exposed and excised.  Now that the lid is dropping back to the position that it should assume, the extra skin is removed.  The wounds are stitched with a fine synthetic  material (Prolene) which is removed in one week.

I discharge patients on the day of surgery with instructions to use ice compresses and return to the office in 24 hours.  We never offer pain medication as there is no need for any.  On the first day the wound is cleaned and folks are asked to return in a week.  They are to use ice for the next few days and at the same time they can be up and around; driving, desk work, etc is O.K. 

Bruising from the surgery is related to the amount of bruising that folks normally experience.  To minimize the bruising I ask patients to discontinue aspirin and anticoagulants well in advance of the day of surgery.  If your medical condition does not allow for the discontinuance of these medications, you are not a candidate for eyelid surgery.

In many instances, I am able to get patients qualified with their health insurance company  (including Medicare and Medicaid), to pay for the surgery for the upper eyelids; lower eyelid surgery is usually considered cosmetic and not paid. There are some exceptions in the case of drooping lower eyelids causing tearing (ectropion).

Call the office, come in and let’s talk about your specific situation.