Eye Surgery & Lasers
We perform complete and thorough routine and medical eye examinations for people of all ages using a variety of advanced instruments and techniques which make it possible to diagnose conditions both inside and outside the eye.
Drs. Cassel and Ratner are board certified ophthalmologists and specialize in eye surgery including cataract, lens implant, and laser surgery, as well as the treatment of glaucoma, corneal and retinal disorders, and many other eye problems. These doctors are also available to give second opinions on cataract surgery, and the diagnosis and treatment of other medical and surgical eye problems. The excellent surgical and laser facilities and equipment at Greater Baltimore Medical Center and our affiliation with the Johns Hopkins Hospital further aid them in providing total and state of the art eye care to our patients.
Cataract SurgeryModern phacoemulsification cataract surgery is still a very successful operation with few complications for patients where cataracts are the cause of significant vision impairment. This modern surgical technique has made it possible to remove cataracts at earlier stages of development based on the level of visual problems they are causing, not on their degree of maturity. Our doctors continue to offer modern cataract surgery techniques to our patients needing this surgery. They also perform these operations in state-of-the-art hospitals and outpatient facilities in our community.
Pain-free Cataract SurgeryCataract surgery is a pain-free experience thanks to advances in anesthesia. Our patients are very comfortable during the surgery and are able to resume normal activities shortly afterwards. During this procedure, Dr. Cassel and members of his surgical team at Greater Baltimore Medical Center (G.B.M.C.) attend to your needs and lessen your anxiety about surgery. It is also comforting to have your surgery at one of the leading hospitals in our state, with a highly trained staff of nurses, surgical assistants, and anesthesia personnel.
"No-Stitch" Cataract Surgery
Years ago, before there were sutures small enough to close eye incisions, cataract patients needed to remain still in bed for weeks after the surgery to allow time for the wound to heal. Sandbags were placed around the head to prevent movement. Although sutures eventually proved to be a major advance to cataract surgery, they have now been supplanted in most cases by the use of a self-sealing incision. The shape of the incision creates a flap that takes advantage of the natural fluid pressure inside the eye to seal it shut without the need for sutures.
Not every cataract surgery can be performed as a "No-Stitch" procedure. The decision to place a suture is made by Dr. Cassel at the time of cataract surgery. He may choose to place a suture in the wound for added support in very active patients or those at risk of falling or being forgetful and rubbing their eye after this microsurgical cataract procedure. With or without sutures, however, small self-sealing incisions have been a major benefit for our patients who have undergone cataract surgery providing shorter surgery time, dramatically reduced recovery time, less surgically induced astigmatism, and less discomfort after surgery.
Using a Self-Sealing Wound
Do cataracts need to be "ripe" before they can be removed?This was true many years ago but is not any more. Modern microsurgical techniques have made it possible for us to remove cataracts (a haziness which develops over time in the eye's lens) at any stage. Surgery, however, should only be performed when cataracts are causing you significant problems with your eyesight, such as trouble with your distance vision, difficulty seeing to drive (particularly at night), reading problems, glare, ghost images or double vision in one eye, or a halo around lights. We perform many cataract operations each year. These are never performed just because they are "ripe" but are based on how the cataract is effecting your visual needs.
Glaucoma SurgeryTrabeculectomy (filtering surgery) is the type of operation most often used to reduce pressure in eyes with glaucoma. Trabeculectomy is usually done when medication and laser treatment for glaucoma have failed to reduce the pressure in the eyes enough to prevent damage to a person's eyesight. Filtering surgery (lowering the eye pressure) has a high success rate, and many patients are able to stop or reduce their glaucoma eye drops afterwards. Of course, as with any surgical procedure, there are risks including the possibility of bleeding and infection. In rare cases, complications can lead to blindness. Drs. Ratner and Cassel have had good success with this procedure. They consider the benefits of filtering surgery in all their glaucoma patients who have not responded to conventional drops or laser surgery for glaucoma.
Glaucoma, Cataracts, & RetinaOur doctors are specially trained in the use of lasers for glaucoma, retinal disease, and for opacified posterior capsular scarring after cataract surgery. Although many people still believe that cataract surgery is performed using lasers, please be assured that this is a misconception. Dr. Cassel performs phacoemulsification cataract surgery using the most modern technology currently available to eye surgeons. If necessary, our doctors use lasers as a second step after to remove visually impairing scar tissue build-up that can accumulated behind the implant lens in the eye following cataract surgery.
LASIK Refractive Eye SurgeryAre you tired of all of the advertising? Are you suspicious about why the price of Lasik keeps dropping? We are sure that by now you have figured out that this is all necessary to attract patients because the truth is that refractive surgery is not always successful. This is well-documented at the web site www.surgicaleyes.org. A recent article in the Baltimore City Paper said there is "a lot of frustration, for there is no plan B for improving laser-botched vision." Remember, this is your eyesight, not something that you can return to the store if you don't like what you bought. Sure, we all know people who feel they are seeing better after Lasik, but are they really? Studies have shown that many of these people are not seeing as well after the procedure as they did before when they were wearing their glasses and contact lenses. For those of us who demand the best vision we can get all of the time, glasses or contacts are still the safest and most dependable option.
TREATMENTS OF EYE PROBLEMS
Punctal Plugs for Dry EyesBlocking the drainage of tears from the eye by placing plugs in the puncta (the tear duct opening in the eyelid) has become a very popular and effective means of treating dry eye patients when conventional tear drops and ointments do not provide a significant amount of relief. Many new varieties of punctal plugs have become available this year. Dry eye patients should ask us at their next visit if this treatment is appropriate for them. You can also call our office and speak with Dr. Flemke for more information about the use of punctal plugs in dry eyes.
I have tried eye drops for my dry eyes but they only work for a short time and are inconvenient to use. Is there anything else I can try?
Yes. We have had a lot of success treating people with dry eyes by closing off the tear duct either with punctal plugs or thermal cautery. Punctal closure acts like putting a stopper in the drain of a sink. This keeps whatever tears you have from flowing out of the eye, increasing the moisture in your eye similar to the way the stopper prevents water from draining out of a sink. These procedures, with or without tear supplements, can be a big help for people with dry eyes where artificial bottled tear drops alone are not helping. Ask us about punctal closure if you want more information.
NEWER EYE MEDICATIONSVigamox belongs to the family of medicines called antibiotics. Vigamox ophthalmic solution (eye drops), a new generation of antibiotics, is now available to treat infections of the eye, such as bacterial conjunctivitis. Sincee it eliminates a very broad spectrum of bacteria and is unpreserved so it's easy on the eye, Vigamox also provides excellent antibacterial coverage for our patients at the time of their eye surgery.
Xalatan, Travatan and Lumigan are among a new class of glaucoma drugs called prostaglandins. Your body produces prostaglandins naturally for many things. In the eye, one particular prostaglandin has been shown to help the fluid flow out by opening alternative drainage canals, thus keeping the eye pressure from becoming elevated. These medications work similarly to this natural prostaglandin and are believed to increase the fluid outflow through this secondary drainage system. NATURE'S TEARS is an all-natural moisturizing mist spray for the eyes. Studies of NATURE'S TEARS and dry eye patients showed, on average, that the mist spray doubled the moisture volume of the eyes' tear film without disrupting the tear film's delicate structure. Contact lens wearers were the most enthusiastic. The mist creates a microenvironment of pure, all-natural, unpolluted pH correct humidity around the face. NATURE'S TEARS spray is available in our office without the need for a prescription.
The U.S. Food and Drug Administration has approved Restasis as the first and only therapeutic treatment for patients with dry eyes. A trial of Restasis is recommended when conventional tear drops, ointments, mist, and other treatments have not significantly benefited a patient and if tear production is suppressed due to ocular inflammation. Restasis became available in the U.S. market in April 2003. Its primary ingredient is cyclosporine A, an immunosuppressive agent used in organ transplantation. The anti-inflammatory effect of topical cyclosporine A improves overall tear function and/or production and restores mucin production by tear glands of the eye.