Posts Tagged ‘Dr. Raymond Stein’

Update on Corneal Collagen Crosslinking (CXL) for Keratoconus

Friday, January 21st, 2011

The surgeons of the Bochner Eye Institute wrote the following clinical update. We hope you find it of interest.

At the Bochner Eye Institute we were the first in North America to introduce CXL using Riboflavin drops and epithelial removal in January 2008. Over the past 3 years we have treated over 2,000 keratoconic eyes with encouraging clinical results. Based on patient treatments we are now considered the most experienced centre for CXL worldwide.

As you may know, the main goal of CXL is to halt the progression of keratoconus and prevent the need for a corneal transplant. At the Bochner Institute patients have ranged in age from 10 to 60 years. The earlier the treatment the better the long-term prognosis. We have not seen a case of progressive ectasia post-CXL. A minimum corneal thickness of 400 microns is required prior to CXL. In corneas between 300 and 399 microns, we have been successful in inducing transient corneal swelling with hypotonic drops to achieve a minimum thickness over 400 microns to safely perform the UV-A laser application.

Dr Raymond Stein was recently invited to present our CXL outcomes at the American Academy of Ophthalmology in Chicago in October 2010. This is the largest ophthalmic meeting in the world with an attendance of over 20,000. The 24-month outcomes were reported that were followed with a refraction, pachymetry, and Pentacam analysis. Some patients achieved up to 8 diopters of flattening, although the average central flattening was one diopter. Topographic difference maps often showed flattening of steep areas and steepening of flat areas to enhance the overall corneal curvature and improve best-corrected spectacle acuity. During the first month postoperatively the uncorrected visual acuity and best-corrected visual acuity is often decreased as the epithelium undergoes remodeling or maturation. At 4 to 6 months postoperatively, 60% of eyes showed an improvement of one or more lines of vision.

In Europe, which started CXL 12 years ago, the procedure is now being rapidly adopted as the standard of care for keratoconus eyes with progressive disease. Long-term data from Europe has shown a primary success rate of 98% in halting disease progression in corneas with an initial steepness of less than 58 D. If there is progressive steepening the procedure can be repeated with good results.

At the Bochner Eye Institute we continue to treat patients from as far away as Miami, Dallas, and Los Angeles. We have treated a few NHL hockey players as well as children of ophthalmologists and optometrists. This breakthrough technology is showing significant clinical benefits.

More about Clinic Director Raymond Stein MD

Femtosecond Laser for Creation of LASIK Flap

Friday, January 21st, 2011

Dr Raymond Stein of the Bochner Eye Institute wrote the following clinical update. We hope you find it of interest.

Many reports have demonstrated the superiority of Femtosecond laser created flaps over a microkeratome blade: increased flap thickness accuracy,1,2,3 greater consistency of flap thickness,4,5 the elimination of buttonhole flaps,1,6 decreased epithelial injury,4, 7, greater flap adhesion strength, 8 ,faster visual recovery and better uncorrected visual acuity,8,9 improved contrast sensitivity,10 better refractive astigmatic neutrality,5 decreased higher order aberrations,11 and decreased corneal insensitivity and tear function compromises.12,13

The laser flap has a uniform or planar thickness. A blade creates a meniscus flap which results in a thinner flap in the centre and thicker in the periphery. This can lead to one of the most dreaded LASIK complications of a button-hole. This can result in loss of best-corrected vision from irregular astigmatism or scar tissue. When we acquired a Femtosecond laser 4 years ago we thought initially we would offer both the Femtosecond and blade technologies. After doing our first cases we quickly sold our microkeratome. All prospective laser patients should be aware that the Femtosecond laser provides the most technologically advanced and safest procedure.

Why would some laser centres today offer inferior technology? The answer is very clear cost. The purchase of a Femtosecond laser costs around $500,000, there is an annual maintenance fee of around $70,000, and a disposable cost (suction ring) of approximately $200 per eye. A microkeratome can be purchased for $25,000 or less, there are no annual maintenance fees, and the cost of a blade is around $50 for both eyes. So you can see from a cost point of view there are significant savings to a laser centre to offer inferior technology with a microkeratome.

Femtosecond technology continues to advance. At the Bochner Eye Institute we acquired the first IFS laser in Canada, which has a speed of 150 KHz. This is 2.5 times faster than the previous laser technology. This results in the suction ring being on the eye for less time resulting in a more comfortable experience for the patient. In addition the new technology can create a flap edge greater than 100 degrees. This leads to a more stable flap position like a man-hole cover, and a lower incidence of epithelial ingrowth.

At the Bochner Eye Institute we continue to treat a significant number of eye-care professionals from across Canada and the United States. We feel this is because eye doctors understand leading edge technology and trust our surgical techniques and abilities.

1.Binder PS. Flap dimensions created with the Intralase FS Laser. J Cataract Refract Surg. 2004;30:26-32.

2. Javaloy J, Vidal MT, Abdelrahman AM, Artola A, Alio JL. Confocal microscopy comparison of Intralase femtosecond laser and Moria M2 microkeratome in LASIK. J Cataract Refract Surg. 2007; 23:178-187.

3. Patel SV, Maguire LJ, McLaren W, Hodge DO, Bourne WM. Femtosecond laser versus mechanical microkeratome for LASIK: a randomized controlled study. Am J Ophthalmol. 2007;114:1482-1490.

4. Kezirian GM, Stonecipher KG. Comparison of the Intralase femtosecond laser and mechanical keratomes for laser in situ keratomileusis. J Cataract Refract Surg. 2004;30:804-811.

5. Talamo JH, Meltzer J, Gardner J. Reproducibility of flap thickness with Intralase FS and Moria LSK-1 and M2 microkeratomes. J Cataract Refract Surg. 2006;22:556-561.

6. Binder PS. One thousand consecutive IntraLase laser in situ keratomileusis flaps. J Cataract Refract Surg. 2006;32:962-969.

7. Duffey RJ. Thin flap laser in situ keratomileusis: flap dimensions with the Moria LSK-One manual microkeratome using the 100-micron head. J Cataract Refract Surg. 2005;31:1159-1162.

8. Knorz MC, Vossmerbaeumer U. Comparison of flap adhesion strength using the Amadeus microkeratome and the IntraLase IFS femtosecond laser in rabbits. J Refract Surg. 2008;24:875-878.

9. Durrie DS, Kezirian GM. Femtosecond laser versus mechanical keratome flaps in wavefront-guided laser in situ keratomileusis: a prospective contralateral eye study. J Cataract Refract Surg. 2005;31:120-126.

10. Tanna M, Schallhorn SC, Hettinger KA. Femtosecond laser versus mechanical microkeratome: a retrospective comparison of visual outcomes at 3 months. J Refract Surg. 2009;25:S668-S671.

11.Montes-Mico R, Rodriguez-Galietero A, Alio JL. Femtosecond laser versus mechanical keratome LASIK for myopia. Ophthalmology. 2007;114:62-68.

12. Tran DB, Sarayba MA, Bor Z, Garufis G, et al. Randomized prospective clinical study comparing induced aberrations with IntraLase and Hansatome flap creation in fellow eyes. J Cataract Refract Surg. 2005;31:97-105.

13. Lim T, Yang S, Kim MJ, Tchah H. Comparison of the IntraLase femtosecond laser and mechanical microkeratome for laser in situ keratomileusis. Am J Ophthalmol. 2006;141:833-839.

14. Barequet IS, Hirsh A, Levinger S. Effect of thin femtosecond LASIK flaps on corneal sensitivity and tear function. J Refract Surg. 2008;24:897-902.

“The Future of Cataract and Refractive Surgery” by Dr. Raymond Stein

Monday, December 13th, 2010

Dr Raymond Stein was invited to lecture at the University of Toronto, Walter Wright Ophthalmology Conference on Dec 4, 2010 on “The Future of Cataract and Refractive Surgery”. His presentation covered exciting new innovations like Femtosecond Cataract Surgery, Intraoperative Wavefront Analysis , Calhoun Light-Adjustable Lens, Dual-Optic Accommodative Implant, Corneal Inlays, and Microwave Keratoplasty.

Raymond Stein MD (left front)

Raymond Stein MD (left front)

Read Reviews on Dr Raymond Stein

Dr Raymond Stein was an invited guest speaker of the Academy of Ophthalmic Education in Toronto

Monday, November 15th, 2010

Dr Raymond Stein was an invited guest speaker of the Academy of Ophthalmic Education for its annual meeting in Toronto on November 7, 2010. Dr Stein gave a lecture titled the Cornea and Systemic Disease.

Dr. Raymond Stein discussed many important life saving ocular signs that present with initial corneal involvement. He discussed conditions such as Multiple Endocrine Neoplasia Type 2B, Cystinosis, Multiple Myeloma, Superior Limbic Keratoconjunctivitis, and Cogan’s Syndrome. The annual meeting of the Academy of Ophthalmic Education attracted over 1,000 eye-care professionals from across Canada.

Lasik in Toronto Reviews click here

Raymond Stein MD Video – Toronto LASER Eye Surgery- Bochner Eye Institute

Wednesday, October 20th, 2010
Raymond Stein MD - View video click here

Raymond Stein MD - View video click here

To learn more, watch a video about Dr. Raymond Stein

Raymond Stein talks about his past 20 years of Laser Vision Correction- As seen in EyeWorld

Wednesday, October 20th, 2010

“Over the past 20 years at the Bochner Eye Institute, every day has been an exciting day for our patients, our staff, and our surgeons. Patients’ lives are enhanced with a painless, quick, and safe procedure. The most common regret that patients tell us is they wish they had the surgery when they were younger. Today patients who have laser surgery range in age from 18-65 years. In the early days of laser vision correction, it was primarily the risk takers who underwent the procedure. Skydivers, bungee jumpers, and motorcycle riders were commonplace. Today I see a high percentage of chess players, actuaries, accountants, and surgeons who are undergoing the procedure. Many patients don’t have any specific problems with their glasses or contact lenses but want to be free to live their life without any optical aids.” from EyeWorld

Raymond Stein as seen in EyeWorld

Raymond Stein MD as seen in EyeWorld at recent ASCRS meeting in Chicago

More about Raymond Stein

Lasik in Toronto Reviews Bochner Eye Insitute

Lasik in Toronto
40 Prince Arthur Avenue
Toronto, ON M5R 1A9
(416) 960-2020

If you had Canada’s top eye surgeon, Dr. Raymond Stein, cornered for 10 minutes, what would you ask him?

Wednesday, September 8th, 2010

Post City Magazines- Raymond Stein MD

DR. RAYMOND STEIN is a pioneer in the development of laser eye surgery, having more than 20 years of experience and having performed more than 80,000 surgeries. In addition to his work at Bochner Eye Institute, Dr. Stein is also chief of ophthalmology at the Scarborough Hospital in Toronto and a cornea consultant at Mount Sinai Hospital.

My kid loves to read in the dark. Is that bad for her eyes?

Is that the same for sitting too close to the TV?

What about carrots?

What about e-readers and iPads?

When should children get their first eye checkup?

What are the risks of laser eye surgery?

Why do eyes twitch? I get that a lot.

Premium Intraocular Implants with Dr. Stein

Thursday, November 19th, 2009

Premium Intraocular Implants

All patients that are to have cataract or refractive lens exchange surgery need to be aware of their implant choices. Dr. Raymond Stein provides all his Toronto patients with detailed information on all the available options. He will tell them if they are, or are not, a candidate for a specific type of lens. The worse scenario is a patient that has surgery with a standard implant and only later discovers from a friend that they could have had a premium lens (multifocal, toric, or aspheric implant). Not all patients will choose a premium lens but it is important that they are aware of their options.

There have been significant advances in multifocal or accommodative implant technology over the past year. The most impressive implant has been the Restor +3 add from Alcon. This implant has consistently provided distance, intermediate, and near vision. In 2004 Dr. Raymond Stein was the first surgeon in Canada to implant the Restor +4 add. This implant provided distance and near vision but intermediate vision was difficult for the majority of patients. The new Restor +3 add represents breakthrough technology. Some patients may have some glare at night but this is typically mild and in a high percentage of cases diminishes over 6 months. For patients that desire a reduced dependency on glasses the Restor +3 add is Dr. Stein’s implant of choice. If patients are not satisfied with their refractive outcome then a refinement can be accomplished with laser vision correction.

Clinical results of the Toric implant from both Alcon and Rayner have been superior over limbal relaxing incisions for astigmatism. For patients with 1 D or greater of preoperative astigmatism the Toric implant is the lens of choice. This implant can be custom ordered to correct up to 6 D of cylinder. The lens is orientated in the eye along the steep meridian. These implants are made of an acrylic material that adheres to the posterior capsule and prevents rotation. Although limbal relaxing incisions are an alternative method for dealing with preoperative astigmatism the results are highly variable as the effectiveness of the incisions are dependent on the biomechanical properties of the cornea.

For patients that are either not candidates or are not interested in a multifocal or toric implant an aspheric implant is an excellent choice. The cornea normally induces positive spherical aberration and the crystalline lens, at least when we are young, balances this by producing negative spherical aberration. As we get older the crystalline lens changes with the net result that patients have positive spherical aberration. This leads to diminished quality of vision especially at night. An aspheric implant will counter the positive spherical aberration of the cornea, which usually results in superior quality of vision.

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International Television Show Style by Jury Featuring the Bochner Eye Institute

Friday, July 17th, 2009

The Bochner Eye Institute and Dr Raymond Stein have been selected over the past 2 years to be the exclusive provider of laser vision correction services for the popular international TV show Style by Jury. Each show highlights the life altering changes of one individual as judged by a jury. In addition to LASIK or PRK, patients usually undergo dental restoration, minimally invasive cosmetic surgery, as well as being provided with a life coach to enhance their confidence and realize their career or personal goals. The show which originated in Toronto is now syndicated in 22 countries including England, France, Australia, and the United States. The show is shown weekly in New York and Chicago.

wnetwork-buttonThe show is broadcast in Canada on the W channel (# 27) on Tuesday at 8:30 pm.

For further information on the Style by Jury show you can review the website.

View Dr. Raymond Stein ‘s articles.

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Update on Corneal Collagen Crosslinking (CXL) for Keratoconus

Friday, July 17th, 2009

At the Bochner Eye Institute we were the first in North America to introduce CXL using Riboflavin drops and epithelial removal in January 2008. Over the past 1.5 years we have treated 495 keratoconus eyes with encouraging clinical results.

The main goal of CXL is to halt the progression of keratoconus and thus prevent the need for a corneal transplant.. At the Bochner Institute patients have ranged from 11 to 60 years of age. The earlier the treatment the better the long-term prognosis. We have not seen a case of progressive ectasia post-CXL. Our minimum corneal thickness has been reduced from 400 um to 300 um with the technique of inducing corneal swelling prior to crosslinking.

Dr Raymond Stein was invited to present clinical results at the annual Canadian Ophthalmological Society meeting in Toronto June 2009. The 12 month results of 30 eyes were reported that were followed with a refraction, pachymetry, and Pentacam analysis. Some patients achieved up to 8 diopters of flattening. Topographic difference maps often showed flattening of steep areas and steepening of flat areas to enhance the overall corneal curvature and improve best-corrected spectacle acuity. Sixty percent of eyes showed improvement of one or more lines of vision.

As in Europe which started CXL 11 years ago the procedure is now being rapidly adopted as the preferred treatment for keratoconus eyes with progressive disease. At the Bochner Eye Institute we are continuing to have patients referred from ophthalmologists and optometrist from as far away as Miami, Dallas, and Los Angeles.

If you would like further information on CXL or an opportunity to view a procedure please contact one of our refractive surgery consultants Ms Kristin Mallon (KMallon@Bochner.com), Mr Peter Schilling (PSchilling@Bochner.com, or Ms Lynn Maund (LMaund@Bochner.com).

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